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Application Form

Possession Certificate
Document Details: Bal
House Owner Narme" Bhukya Gayat Father /Husband Name:

Door No: rl8 Locality /Landmark' :Amrdagur


Andagu
District:
S ty Mandal:

vilage/Ward'
éo, ooo :dogu
Pin code:

Income: Age": 23
Survey No: Extent": Acres/Cepe fountas
Purpose touu
Ration Card No: Aadhaar Card No:

Informant Details: 22go5O60


informant Name:

Relation:0FatherDMother D Son Daughter Brother Sister Husband Wife self


O Daughter In- law

Moble: fo |1 S4141 Phone:

Email:
Delivery Type": Manual Post-Local I Post -
Nonlocal

House Boundaries:
Name of the House/Land holder

Cyoead
East
West*
North
South
Thìmmem

Applicant's Signature
Documents to be enclosed:
1. Application Form'
2. Income Certificate
(- Indicates Mandatory)

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