duso 0. 6 (comes 8 ewetch) sogass ((@ Government of Qamee Department of Medical & |Wj Health Services Does GjOHS6eo s5s500 DEATH CERTIFICATE (ISSUED UNDER SECTION 12/17) REDO HYOROs Hosoaiy - wi soSes Havoc Hgwrsxio 6 80d adir0008 ide DSdine 7g ‘Soyeo (pas DoaKr) REBIIC BIOS HORII, EMVIO MER , HOGEET rgISr, Roddie we OMG HOS hiEoD Ff Shtdossyesa This is to centfy that the following information has been taken from the Original Record of Death which is in the Register for Citele.-...r0n0 eu (Local area} Division oF ICHAPURAM MUNICIPALITY of SRIKAKULAM DISTRICT of And Hadesh St | Lao Name Qo Joueé: + } 2. Qetoe / & Sex 4 \ mole (2 pony sense Permanent Address Gumoug Palace Tne pas pp otras 4 S386008 86 Date of Death a | 5. soemiie won goso | Place of Death + Palace Tens? (5. sow 1 69 / 6g 6 Nameot Far Maer or tins eee er ee (2. sethat sone Registration No ( eaiySis doves ds Date of Registration: ry , Jo Ds 9G 2004. | (oe ‘Seal: Sains Baier Sasso Prepared bj aid - oo Nay 0b dase Sout SSE Sem Compared by By BS Goret Tisles Ya" Sipayrure off issuing: Authority morse aR eee Note ; In the case of death, no disclosure shall be made of particulars eoeig the JJ cause of death as entered in the Register, See Proviso to section 17(1