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: Signature of the House Owner
Name:
Address: _____________________ ______________________________ ______________________________ PAN No: _____________________