TOURIST TAX EXEMPTION FORM

I, the undersigned, _________________________________________________________________________
                                       (first name/s, surname)

born in ______________________________________ on __________________________________________
                                       (city, country)                                                                         (date of birth, day/month/year)

tax code ______________________________________

residing at ________________________________________________________________________________
                                       (full home address: street, number, city, country, zip code)

Tel. ______________________________________ email__________________________________________
                                       (phone number)                                                                         (email address)

In reference to the stay of ___________ people    from _____________________ to _____________________ 
                                                       (number)                                           (arrival date)                                (departure date)  

at _______________________________________________________________________________________
                                       (name of accommodation facility)                                                                         

located at  _______________________________________________________________________________
                                       (address of accommodation facility)                                                                         

HEREBY  DECLARE
(pursuant to Presidential Decree no. 445/2000, Consolidated Act on Administrative Documentation)

that _______ (indicate number) people in the group are entitled to the exemption envisaged by article 3 of the Rules of Application of the Tourist Tax for the following reasons:

no. of people	Reason	
	a) Children aged less than 14 years. 	
	b) People assisting a family member admitted to local hospitals, who need to stay in accommodation facilities in the municipality area of Rosignano Marittimo. 	
	c) People who are not residents, but work and live in accommodation facilities in the municipality area of Rosignano Marittimo. 	
	d) People who have to stay in accommodation facilities owing to measures taken by the authorities, because of any emergency due to disasters, natural or otherwise, or humanitarian aid 	
	e) Disabled people, who are not self-sufficient (with medical certificate), and their helpers. 	
	f) Schoolchildren on a field trip to institute 	

Informative report ex art. 13 Leg. Decree No. 196/2003 for the handling of personal data
In observance of the provisions of article 13 of Leg. Decree 30th June 2003, no. 196, the City of Rosignano Marittimo, in its legal capacity as Data Controller and Data Processor for personal information, hereby informs you that the data you have provided will be handled (including the use of computerization) exclusively for purposes of the present proceeding in full accordance with the law. The manager of the accommodation facility is required to keep this declaration for a period of five years in order to permit the tax controls conducted by the Municipality of Rosignano Marittimo in its capacity as Data Controller.
Within the context of this processing, you are entitled to exercise the rights defined in article 7 of Leg. Decree no. 196/2003.

Signature

Rosignano Marittimo, _____________________                              ______________________________
                                                    (date)
Attachments:

ý Copy of a valid ID of the applicant.
¨ Medical certificate

Rev. 2 of 15/05/2013