8/13/2021 Public Service Management Madhya Pradesh

Madhya Pradesh Government

Office Designated Officer, Nagar Nigam Area,112-113 palika
plaza Indore
Tappa/Tehsil   Juni Indore   District    Indore

Q.No.  RS/439/0110/51300/2021   /B-121/2021 Dated   17/08/2021  

local resident certificate

       Certified that Mr./Mrs./Kus. Phool Singh Pal father/husband Madhav Singh Pal resident 73
Ramapati Vihar Colony Indore, Kasba Indore 1, Kasba Indore 1,Juni Indore, Indore Tehsil
Juni Indore District Indore (Madhya Pradesh) Effective for issuance of local resident certificate
of Madhya Pradesh by the State Government As a result of fulfillment of clause number (iii) of the
criteria prescribed in the memorandum dated 20/12/2011 , he is a local resident of Madhya
Pradesh.
2. * Certified that as per the details given by the applicant under the Memorandum No. C-
3/17/1/3/2011 dated 20/12/2011 of the Government of Madhya Pradesh, General Administration
Department, the applicant's wife * / minor children * whose The details are mentioned below, is a
local resident of Madhya Pradesh -

(1) Applicant's wife's name is Meera Devi Age 42 years.

(2) Minor son/daughter and age of the applicant

serial minor son/daughter age (years)

number
1 Rishikesh 17

Note: - This certificate will not be admissible for consideration for evidence in the verification of caste certificate issued for
caste determination.
(issued on the basis of declaration form submitted by the applicant)

Meenakshi Harvansh
 
*Strike out if not applicable. Authorized Officer

Note :- Issued by the officer authorized by the District Collector

Note: - Registration number: RS/439/0110/51300/2021 can be verified by giving this registration number on the website
lokseva.gov.in or mpedistrict.gov.in.

Certified that the printout of this letter has been taken out by me from the website www.mpedistrict.gov.in.

Signature

mpedistrict.gov.in/Public/ViewCertificateSP_Public.aspx?param=Gi9zUdngBeF0jzng3afBeYN37D5E0JRK3zoNBURjhwM= 1/1