సంఖ 1

ఆంధ పే పభుతము

No. 1
ా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 KOMARIPALEM

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... . కోలు లా .. తూరు ోావి ా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 KOMARIPALEM OF TAHSIL/BLOCK BICCAVOLU OF DISTRICT EAST GODAVARI OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

మరణింన వి రు / NAME OF DECEASED : JAMI VENKATA RAMANA ంగము / SEX: पुरुष / MALE

ఆా సంఖ / AADHAAR NO.:

XXXXXXXX5086

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

18-09-2020 1-204, JAMI VENKATA RAMANA, RAMANNAPETA, KOMARIPALEM,
EIGHTEENTH-SEPTEMBER-TWO THOUSAND TWENTY BICCAVOLU, EAST GODAVARI, ANDHRA PRADESH, 533346.

భర / ర రు / NAME OF HUSBAND / WIFE:

మరణింన వి క వయసు / AGE OF DECEASED: JAMI KARUNA
45 YEARS
ఆా సంఖ / HUSBAND/WIFE AADHAAR NO. :
---

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

JAMI NAGARATNAM JAMI CHINNAYYA

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 DEATH మృతు ిరాసప రుామ / PERMANENT ADDRESS OF DECEASED
: :

1-204, JAMI VENKATA RAMANA, RAMANNA PETA, 1-204, JAMI VENKATA RAMANA, RAMANNA PETA,
KOMARIPALEM, BICCAVOLU, EAST GODAVARI, KOMARIPALEM, BICCAVOLU, EAST GODAVARI,
ANDHRA PRADESH- 533346 ANDHRA PRADESH- 533346

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

D-2020: 28-03449-000041 21-09-2020

ేాంశములు / REMARKS (IF ANY):

---

ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY
21-09-2020
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)
GRAMA PANCHAYAT KOMARIPALEM

UPDATED ON :
2020-09-21 11:55:09

"THIS IS A COMPUTER GENERATED CERTIFICATE. "

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 "