సంఖ 1

No. 1 ఆంధ పే పభుతము ారం-6

GOVERNMENT OF ANDHRA PRADESH FORM-6
ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

GRAMA PANCHAYAT KANCHARM

మరణ ధృవ పతము

DEATH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION OF BIRTHS & DEATHS
RULES 1999.)

ఈ ింి సమాా మరణం నదు క అసలు ిారు ాషం క... ామ పంాయ కంచరం . ాజంలా .. ాళం ాలూా / బా ుంి సుోబింి అ సరిౖ ేయడం
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR GRAMA PANCHAYAT
KANCHARM OF TAHSIL/BLOCK RAJAM OF DISTRICT SRIKAKULAM OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

మరణింన వి రు / NAME OF DECEASED : YALAKALA PADMA ంగము / SEX: महिला / FEMALE

మరణింన ేి / DATE OF DEATH: మరణింన పేశం / PLACE OF DEATH:

04-06-2019
FOURTH-JUNE-TWO THOUSAND NINETEEN 8-99, SLAB HOUSE , TANKALA VEEDI, KANCHARAM, KANCHARAM, RAJAM, SRIKAKULAM,
ANDHRA PRADESH, 532127. /
, ాజం, ాళం , , 532127.
మరణింన వి క వయసు / AGE OF DECEASED:
30 YEARS భర / ర రు / NAME OF HUSBAND / WIFE:
YELAKALA APPALA NAIDU

ఆా సంఖ / HUSBAND/WIFE AADHAAR NO. :

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER :

AVALA NARAYANAMMA AVALA RAMI NAIDU

ఆా సంఖ / MOTHER'S AADHAAR NO. : ఆా సంఖ / FATHER'S AADHAAR NO. :

మరణింనపడు మృతు రుామ / ADDRESS OF THE DECEASED AT THE TIME OF మృతు ిరాసప రుామ / PERMANENT ADDRESS OF DECEASED :
DEATH :
8-99, SLAB HOUSE, TANKALA VEEDI, 8-99, SLAB HOUSE, TANKALA VEEDI, KANCHARAM, KANCHARAM, RAJAM, SRIKAKULAM,
KANCHARAM, KANCHARAM, RAJAM, SRIKAKULAM, ANDHRA PRADESH- 532127 ANDHRA PRADESH- 532127

ాజం, ాళం , ాజం, ాళం , - 532127

532127

నదు సంఖ / REGISTRATION NO: నదు ేీ / DATE OF REGISTRATION:

D-2019: 28-00805-000016 10-06-2019

ేాంశములు / REMARKS (IF ANY):

NILL

ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY
10-06-2019
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)

GRAMA PANCHAYAT KANCHARM

UPDATED ON :
10-06-2019 11:41:23

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.
" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "