The note from a firefighter left on the white coffin of one of the young victims of the devastating earthquake in central Italy summed up the despair of a nation as the death toll reached 290.

“Forgive us if we arrived too late,” it read.” I'd like you to know that we did all we could to pull you out.”

Giulia Rinaldo, aged nine, was one of 35 victims remembered at a mass state funeral held yesterday at a community gym in Ascoli Piceno, during a national day of mourning.

She was found on top of her little sister Giorgia, four, who was pulled out alive from the rubble after being buried for several hours. Italian media reported she had survived thanks to a pocket of air created by the position of her sister’s body.

The service took place after more victims were pulled from the ruins. But it is feared the number of fatalities may rise further with the search operation continuing and several people remain unaccounted for.

President Sergio Mattarella and Premier Matteo Renzi attended the state funeral service, led by Bishop Giovanni D'Ercole who told the mourners “not to lose courage”.

"Only together can we rebuild our houses and our churches,” he said. “Together, above all, we will be able to restore life to our communities."

The worst hit town was Amatrice, which now has 230 confirmed deaths and where the death toll has been rising. Elsewhere, 11 were killed in Accumoli and 49 in Arquato del Tronto.

Three British citizens are known to have been killed in the earthquake – teenager Marcos Burnett, 14, who was from London and on holiday with his parents and sister. The rest of his family suffered minor injuries but survived when the building they were in collapsed.

Maria Henniker-Gotley, 51, and her husband Will, 55, from London, who owned the property, were also killed. Their two children, believed to be aged 12 and 14, survived.

Other victims included a married couple on holiday who lived in a town near Rome, who were found crushed under the rubble of a house in Amatrice in an embrace.

Four members of one family, including two grandmothers, and an earthquake expert who spent most of her life working for Italy’s Civil Protection disaster management agency were also among those killed.

At least 388 people were treated in hospital for injuries, while more than 2,000 people were made homeless by the earthquake.

President Mattarella visited the town of Amatrice before the state funeral service to see the extent of the damage – but could only survey it from the outskirts as it is too dangerous to enter the once-picturesque town centre.

Overnight on Friday, residents of the area were thrown into panic yet again by a series of aftershocks. The strongest, at 4.50am local time, had a magnitude of 4.2, according to the US Geological Survey.

Italian scientific authorities say satellite images show the ground below Accumoli sank 20cm due to the initial earthquake, which had a magnitude of 6.2.

Many of the people left homeless have been spending their nights in tent cities where volunteers have been working to provide basic amenities.

Flags flew at half-mast and those hit hardest by the tragedy expressed their grief.

Many children and elderly people were killed and children being mourned at the state funeral included an 18-month old girl, Marisol.

"It is a great tragedy. There are no words to describe it," said Gina Razzetti, a resident of Ascoli Piceno who joined hundreds of local people for the funeral.

"Each one of us has our pain inside. We are thinking about the families who lost relatives, who lost their homes, who lost everything."

"The melancholy grabs on to your heart, you feel a sense of weakness, of depression," said Fiore Ciotto, another resident of Ascoli Piceno. "An event like this weakens you physically and mentally."

The tribute to Giulia Rinaldo, signed by a firefighter known only as Andrea, was just one of many paid yesterday as the country struggled to comprehend the scale of the devastation.

His touching note ended: “When I return to my house in l'Aquila, I will know that there is an angel watching me from the sky. You will be a shining star in the night. Bye Giulia, I love you even though you never got to know me."