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OFFICE OF THE GRAMPANCHAYAT

LANKAHUDA
Block:- Sadar, Dist:- Sundargarh
Ref No.
Date.
RESIDENCE CERTIFICATE

This is certify that Sri/Miss/Kumari ………………………………………………………………………………………………….


Son/Daughter/Wife of Sri …………………………………………………………………………………………………………………………
Permanent resident of village ………………………………………………………. Post …………………………………………………
Police station ……………………………………….. Block ………………………………………….. Pin …………………………………..
Under Dist. ………………………………… In the state of Odisha. He/She is belongs to good moral character and
normally person. I know him/her very well to last ………………… year.

I wish every success in his/her life.

D.O.B. …………………………
Full signature of applicant Signature of the sarpanch
With seal

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