President Sergio Mattarella, Prime Minister Matteo Renzi and other leaders were among hundreds of mourners who sat solemnly behind 35 coffins in a sports hall in Ascoli Piceno.
Some 230 of the quake's 290 confirmed victims were buried under tonnes of collapsed masonry in the popular beauty spot's devastated centre.
The hall in the capital of the Marche region had been converted temporarily to a place of worship for the funeral of most of the people who perished in the villages of Arquata del Tronto and Pescara del Tronto in the region's mountainous interior.
Relatives of the dead sat alongside the flower-bedecked coffins, some draping themselves across them and sobbing inconsolably, three days after the deadly earthquake struck before dawn.
Others hugged each other tight as Giovanni D'Ercole, the bishop of Ascoli, implored them not to lose faith.
"Don't be afraid to scream your suffering, but do not lose courage. Together we will rebuild our houses and churches, together above all we will give life back to our communities ... The village bells will ring once more," he said.
Giorgia was one of the last survivors to be rescued and there have been no reports of anyone else being found alive since late Wednesday.
On her sister Giulia's coffin a little note had been left that stated: "Ciao little one. Sorry that we arrived too late." It had apparently been left by one of the workers involved in the rescue operation.
"Giulia died but she was found in a position protecting Giorgia ... Life and death came face to face and for Giorgia, life won," the bishop said.
Three more bodies were plucked from the town's Hotel Roma overnight and there are fears there are still more bodies to be recovered. Amatrice was packed with visitors when the powerful quake struck in the early hours of Wednesday.
Nearly 400 people have been hospitalised since then, some of them with life-threatening injuries.
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