RECEIPT OF HOUSE RENT

(Under Section 1 (13-A) of Income Tax Act )

Received a sum of Rs. ____________________________ (Rupees________________
_______________________________________________________________________
_
Towards the rent @____________________ per month from ___________________ to
__________________ in respect of House No.____________________________
_________________________________________________ situated at ____________
_______________________________________________________________________
(Affix Revenue Stamp of Rs.1/-)

Date:
Name:
Address: _____________________
______________________________
______________________________
PAN No: _____________________

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Signature of the House Owner