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FORM No. I
(See Rute 3)
GOVERNMENT OF ODISHA
Oflice of the Tahasildar Baripada
N,liscellaneous Certificate Case No E_lHCl2O21/82114
LEGAL HEIR CERTIFICATE

This is to certily that the person/persons speciiied

below. is/are the legal heir/heirs of late
MAHABHOI sonof shri LATE SHYAMS!ryDAB
shrisANTosH KUMAB
MAHABHOT ,ot viltage/town DEULASAHT,
uNtr No. 07 ps. BARIpADA
I9Jvl ]"ah?s lB.aripada in the district of MAYURBHANJ inln".iui" or oo,.nu.
I nrs certrlicate is being granted only
for the purpose specitiea in tire oiisna lvliscellaneous
certificate Rules, 20 lg
Purpose:.
relatins to transferot Land anri Buildinss wITHDRAWAL
lfigJtJ;l-: #ilt#ent oF.MoNEy FRoM BANK posr oFFrcE TNSUHANCE

S. No. Name Age Marital Status Belationship Wittr OeceaseA

1 BHARATIMAHA6HCI 2,1 Unmarried Daughter
2. JANMAJAY MAHABI.IOI* ZU Unmarried Son
J. KAI.PANA MAHABHOI %
67 Widow Mother
4.
SARASWATI
MAHABHOI 47 Widow Wife

Oioilsl y signsl
b/ R AIvtA CFAtt0rlA SOREN
Darc202106 20 t2:52.2S rDS:30
Urgnature of the Revenue Olficer
29t06t2021

,,.. This is a Digitaljy Sjgned DocumentAnd Does

Not Require Signature,.".
NO),E (;Jll isa o,gilally s:g;ed etcct,on;calty generated
cetufrcate and rheretorb neeOs no rnrr-signtid signature.

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as per Revenue 8 Disaster
(i,I Ibr any ouery or Ve,iricarior Aqency
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lcferef ce No: E-LHC/ZOZ| tAZt U to Vi.*, httDs://edistrict.odisha.qov.in/t/2os4bl81COB3FC
Token No: 81C0B3FC