Income Certificate Format

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FORM No. Ill (ee Aue 3 GOVERNMENT OF ODISHA Office of the Tahasildar Badasahi Miscellaneous Certificate Case No E-INC/2022/690765 INCOME CERTIFICATE (Valid for the Financial Year 2022-2023 ) This Is to certify that SmtMALATI SOREN daughter of SmtJAUNA CHAPEYAR and Shri GURAI CHAPEYAR, Wio Late CHHOTRAY SOREN is a nativofpormanont resident of the distil of MAYURBHANG In the state of Odlaha and sho/ RASA eee aan tfc Unchaball: PS BADASAHITahasi! Badasahi in the district in tho stato of Odiaha has frit 65000 cciy rom nal volaeeasseaieg beri ‘an annual family \noome os, 66000,00 (Rupees Sixty Five Thousand) [yet 20) Boy ned RAGE uO te202207 1908-1370 9090 Signature of the Revenue Officer 15/07/2022 This is a Digitaly Sianod Documont And Doos Not Require Siqnature NOTE i itis a dightally signed electronically generated cerlfcate and therefore needs no ink-signed signal {i) This Cerificate is Issued as per section 4, 5,8 6 of Information Tachnology Act 2000 and its subsequent amendments in 2008 and as per Revenue & Disaster Managoment Departmont Notification number {MU:13/10-4251/ ROM. {ii) For any Query or Verification , Agency /Departmont / Otice may visit htips:/edistict.odisha.gov.in/ {iv) Tampering of this Cortificate will attract penal action Reference No: E-INC/20221690785 To View: Nips:/editic odisha gov InV4NIScIT7AF1EED Tokon No: OTAFIEED

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