COMUNE DI CASTIGLIONE DELLA PESCAIA
Provincia di Grosseto
Area G.E.F.
Ufficio Tributi
Form B)
DECLARATION OF FAILURE TO PAY THE TOURIST TAX
The undersigned __________________________________ born in _____________ on
CF _______________________, resident in ___________________________________________
Street/Square ______________________ no. _______
__________
 in name and on behalf of
 as a custodial parent parenting on the child _______________________
- aware that with Resolution n. 22 15/03/2013 the Municipal Council of Castiglione della Pescaia introduced
the tourist tax foreseen by article 4 of Leg. Decree 23/2011;
- aware that the omission, dely or incomplete payment of the tax is subject to the administrative sanctions
defined in article 8 of the Rules on the application of the tourist tax;
- aware of the penal sanctions provided for acts of duplicity and false statements, defined in article 76 of DPR
445/2000;
- aware that this statement is given in accordance with articles 46 and 47 del D.P.R. no. 445 of 2000 and
subsequent amendments;
DECLARES



to have stayed ________________________________________________________
(type of accomodation and name)
placed in Street/Square __________________________________________________ n._______,
from________ to_____________ of month________________;
to have decided not to pay the tourist tax to the manager of the facility at the end of the stay.
The amount of the tax due was euro________________, as determined by the length of stay and the rates
approved with the Municipal Council Resolution no. 109 28/03/2013;
and to have decided not to pay the tourist tax for the following reasons:
(specifications of the reasons for neglecting to pay the tourist tax are optional)
_____________________________________________________________________________________
_______________________________________________________________________________
The undersigned declares to want receive all the communications about the proceeding relating to this
statement at the following address: ___________________________________________
___________________________________________________________________
Place and date
_____________________________________
The Declarant
________________________________
Informative report ex article 13 Leg.Decree No. 196/2003 for the handling of personal data
The data you provided to the manager of the accomodation facility, who works as daa controller, are handled exclusively to obtain
the exemption from the tourist tax, in accordance with artiche 4 of the Resolution on tourist tax of the Municipality of Castiglione
della Pescaia. The manager of the accomodation facility is required to preserve this declaration for a period of five years, in order to
permit for the tax controls conducted by the Municipality of Castiglione della Pescaia. The data processor is the Manager of tribute
industry of the Municipality. In every moment you will be able to exercise your rights towards the manager of the accomodation
facility, who receives this statement, and towards the Municipality of Castiglione della Pescaia, both in their capacity of data
controller, as defined in article 7 of Leg.Decree no.196/2003.
5 Vele
2000 - 2012
Legambiente
Touring Club Italiano
Strada Prov.le n. 3 del Padule, Km. 19 - 58043 Castiglione della Pescaia - P.I. 00117100537
Centralino 0564/927111 - Fax 0564/927233-219
e-mail certificata: [email protected]
Telefono 0564/927158 - Fax 0564/927136
Sito Internet: www.comune.castiglionedellapescaia.gr.it
e-mail: [email protected]
.
Bandiera Blu
2000 - 2012
Foundation for
Environmental
Education