FORM NO.

GOVERNMENT OF ANDHRA PRADESH

MEDICAL & HEALTH DEPAKTMENT

Death Certilicate

oed nn Seios l217 of e

is is to certify that the following infornation has been tken fron the original reoord of death
it he register for (local area / local bod) of Mandel
District o of State Andhra Pradesh

me.

le of Death. .&0.06.-2006.
we of Death

ame of Mother

me of Father/Huband.

Permanent Address of Deceased

dclress of the Deceased at the time of Death

egistratiun No..O6
2.0-062006
Date of Registration. uthyy und dr
Signae of yfe insuing
bes / Sen
Kernarks.
20-06-2006.
Date of Issue.
21 o So Fnue egiratine of every bith and Gestt
s sSde 58 S6eta 42bo
 GOVERNMENT OF ANDHRA PRADESH
DEPARTMENT OP HEALTH, MEDICAL ANDFFAMILY WELFARE FORM-6
GRAMA PANCHAYAT GUNDUVARIPALLI

DEATH CERTIFICATE
53LD1999)
LLES UNDER SECTION 12/17 OF
THE
REGISTRATION OF BIRTHS &DEATHS ACT, 1969 AND
RULE 8/13 OF THE
ANDHRA PRADESH
THIS IS TO
CERTIFYOFTHAT THE REGISTRATION OF BIRTHS &DEA
UVARIPALLI TAHSILBLOCK
FOLLOowING OF DISTRICT
AMADAGURINFORMATION HASANANTAPUR
BEEN TAKEN FROM THE
OF ORIGINAL RECORD ÖF DEATH WHICH IS
STATE/UNION TERRITORY ANDHRA PRADESH, INDIA. REGISTER FOR GRAMA PANCHA
THÂ
s
/NAME OF DECEASED :
oy AADHAAR NO.: BUSHANAM KONDAMARAJU
XXA6215 Ooáo / SEX: U0000 /MALE
5 a/
019 DATE OF DEATH:
WENTY-SECOND-FEBRUARY-TWO THOUSAND NINETEEN ádaodS Bbo | PLACE OF DEATH:
3-8,
A.REDDYVARIANDHRA
PALLIPRADESH,
, CHEEKIREVULAPALLI
cbs, ctb/AGE OF
DECEASED:
ANANTAPUR, 515556. , AMADAGUR, AMADAGU
do /aros" NAME OF HUSBAND / WIFE:
BSARASWATHAMMA

eso sos
-MMA
NAME OF MOTHER:
XXXXXXXX3256 HUSBAND/WIFE AADHAAR NO. :
S75Boa dowo |
BANJINEYULUNAME
OF FATHER:
MOTHER'S AADHAAR N0. :
Sodteoa a DaáP | escPQ Soas / FATHER'S AADHAAR NO.
ADDRESS OF THE DECEASED AT THE TIME OF DEATH :
3-8, A.REDDYVARIPALLI, áyáo
TETKIREVULAPALLI, AMADAGUR, AMADAGUR, ANANTAPUR,
DHRA PRADESH- 515556
38JacráF | PERMANENT ADDRESs OF DECEASED
3-8, A.REDDYVARIPALLI,
Deso 3oa,
/REGISTRATION NO: CHEEKIREVULAPALLI,AMADAGUR, AMADAGUR, ANANTAPUR
ANDHRA PRADESH- 515556
9-28-11330-000003 S3Fao b/ DATE OF
tavew/ REMARKS (IF ANY: 27-03-2019 REGISTRATION:

b/DATE OF ISSUE:
Bó eooao / SSUING
AUTHORITY
)
REGISTRAR (BIRTH & DEATH)
GRAMA PANCHAYAT GUNDUVARIPALLI
PDATED ON :
27-03-2019 13:47:16

"THIS IS ACOMPUTER
GENERATED CERTIFICATE WHICH CONTAINS
THE GOVT. OF INDIA VIDE CIRCULAR NO. FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY
APPROVED THIS CERTIFICATE 1/12/2014-VS(CRS)
DOUCMENT FORDATED
a5p, B odaso dsoo AS AVALID LEGAL 27-JULY-2015 FIAS
21 Gre8 syá ALL OFFICIAL
Bobo/ENSURE PURPOSES.
REGISTRATION
OF EVERY BIRTH AND
DEAT