TEMPORARY REGISTRATION for domiciled citizens

The undersigned
Aware that pursuant to art. 76 of DPR 445/2000 the release of false declarations is punished according to the Criminal Code and special laws on the matter, on his/her own responsability

That he/she is temporarily domiciled in:
Together with his/her relative
For more than 3 - less than 12 months
If registrating for the first time or renewing after 30 days, you must attach Your GP’s revocation which You may ask to the District Registry in Your city of residence (for those who have their residence and GP outside the Veneto Region)  
Knowing that his/her Health Authority and City Hall of residence will be informed of his/her registration to Aulss 3 Serenissima
temporary registration as non-resident citizen for himself or for his/her dipendent family members
For his/her under-14 CHILDREN

To promptly inform the Health Authority about any change of domicile or an early return to his/her city of residence, knowing that his/her temporary registration will cease automatically at expiry date and may be renewed by sending a new application proving that the requirements are still fulfilled.

I have read the privacy policy on personal and health data treatment in AULSS 3 Internet site at the following link https://www.aulss3.veneto.it/privacy  and I agree to my personal data treatment for administrative purposes, according to the European Regulation (GDPR n. 2016/679) and Italian Privacy Code (D.Lgs. n. 196/2003, as amended and supplemented by D.L. n. 101/2018).