INDIA NON JUDICAL

Government of Karnataka
e-stamp
Certificate no : IN-KA46380043812410Q
Certificate issued date: 23-APR-2018 01.39PM
Account reference : NONACC (F1)/Kacrsflo8/RAJAJINAGAR/KA-BA
Unique doc.reference : SUBIN-KAKACRSFL0838471394396524Q
Purchase by : K.V.MAHESH
Description of Document: Article 4 Affidavit
Description : Family Tree
Consideration price (Rs):0
[Zero]
First Party : K.V.MAHESH
Second Party : NA
Stamp duty paid by : K.V.MAHESH
Stamp duty amount (Rs) : 20
[TWENTY ONLY]

FAMILY TREE AFFIDAVIT

I Mr.K.V.MAHESH S/O Late K.SANTHAPALAIAH, residing at No. 420/33,Ashirvad, 18th main, 4th ‘T’ Block,
Jayanagar Bangalore-560041, aged about 47 years, do hereby solemnly affirm and state on oath as
follows:-

I Mr.K.V.MAHESH have applied for attestation of family tree and have submitted my present address
No.420/33, Ashirvad, 18th main, 4th ‘T’ Block, Jayanagar, Bangalore-560041 and details of my family
members accordingly
Slno Name Age Relations Aadhar card No Pan card Death
hip with No Certificate
the registration
Applicant No
1 LateK.SANTHAPALAIAH Death Father

2 Late K.KAMALAMMA Death Mother

3 Mrs.K.PADMA GOWRI 44 Sister

Married
4 Mr.K.VENKATESHKUMAR 46 Brother
Married
5 Mr.K.V.MAHESH 47 Self/
Married Applicant

I have also enclosed certified copy of the voter ID. Death certificate and all the documents are genuine
and if any found false or incorrect I am solely responsible for the same and concerned authorities shall
take any legal action against me if any documents above mentioned documents false or incorrect.

This affidavit is to be required for the purpose of KATHA TRANSFER.

What I have stated in this above affidavit is true and correct.

Place:
Date :

Witness with address:

1.

2.