IN THE COURT OF THE EXECUTIVE MAGISTRATE/, MURIBAHAL

In C.M.C No Of 2022

I Rupasa Sahu S/O Sukadeb Sahu aged about 47 year, residence of at/po. Tatopara Ps-Muribahal Dist-
Bolangir (Odisha) do hereby solemnly affirm and state as follow

………… Petitioner

PETITION U/S.13(3) OF THE REGISTRATION OF BIRTH & DEATH ACT.1969

The petitioner named above begs to state as follows:

1. That, the petitioner’s Elder Son residing at the above mentioned address at the time of his Birth Within the
jurisdiction of this Hon’ble Court.
2. That, the petitioner’s Elder Son namely Siddeswar Sahu S/O.Kshiramati Sahu and Rupasa Sahu Birth
on 21-04-2005 at his resident house at Tatopara.
3. That, in advert ant of law and ignorance, the petitioner & his family members could not registered the date
of Birth of his Elder Son namely Siddeswar Sahu S/O.Kshiramati Sahu before the registration, Birth &
Death .e C.H.C, Muribahal as required under registration of Birth and Death Act.1969.
4. That, now the petitioner is in need of Birth certificate of his Elder Son Siddeswar Sahu S/O.Kshiramati
Sahu and Rupasa Sahu.
5. It is therefore, prayed that, your honor may be pleased to condone the delay for non-registration of the date
Elder son of the petitioner with in the period stipulated under the Act. And pass an order directing the
registrar, Birth and death I.c C.H.C Muribahal to register the date of Birth of the Elder son of the petitioner
and issue a Birth certificate of petitioner’s Elder son namely Siddeswar Sahu S/O. Kshiramati Sahu and
Rupasa Sahu For which act of kindness the petitioner as duty bound shall ever pray

Petitioner

Contd..P.2
 AFFIDAVIT

I Rupasa Sahu S/O Sukadeb Sahu aged about 47 year, residence of At/po.Tatopara Ps-Muribahal Dist-
Bolangir (Odisha) do hereby solemnly affirm and state as follow

1. That, I am the petitioner in the above mentioned case.

2. That, the facts stated in the petition above are true to the best of my knowledge, belief and information.

Hence this affidavit

Deponent

Drafted & got typed by me. Read over

explained the contents of this affidavit to the I do hereby declare that the content of this affidavit are
deponents and they admitted it to be true and true to the best of my knowledge and belief. Hence I
correct. I identify the deponents. put my Signature on this the December 23, 2022

Advocate