2.

13 jpUj;jpaikf;fg;gl;l rhd;wpjH;

jkpH;ehL muR
Government of Tamil Nadu
gotk; 6
(tpjp 8 Ig; ghh;f;f)
Department of .....REVENUE...................................................

DEATH CERTIFICATE - ,wg;g[ rhd;wpjH;

( Issued under Section 12/17 of the Registration or Births and deaths Act 1969 and
Rule 8 of TamilNadu Registration of Births and Deaths Rules 2000 )

This is to certify that the following information has been taken from the orginal
record of Death which is the register for (local area) 8 CHANDRASEKARAPURAM of
Taulk Valangaiman of District Thiruvarur of State Tamilnadu.

fPH;fz;l jfty;fs; jkpH;ehL khepyk; jpUthU:h; khtl;lk; tyq;ifkhd;

tl;lk; 8 re;jpunrfug[uk; Ciur; nrh;e;j mry; ,wg;g[g; gjpntl;oypUe;J
vLf;fg;gl;lit vd rhd;wpjH; tHq;fg;gLfpwJ.

Name / bgah; :: mg{h;tk;

Name of Mother/ jhapd; bgah; : -

Name of Father/Husband
: rhkp ma;ah
je;ij / fzthpd; bgah;

Permanent Residential Address of the : Mjp jpuhtplh; bjU

Deceased
,we;jthpd; epiyahd tPl;L Kfthp[

Age / taJ : 68
Sex / ghypdk; : bgz;
Date of Death / ,we;j njjp : 24.05.2017
: Mjp jpuhtplh; bjU
Place of Death / ,we;j ,lk;

Registration No. / gjpt[ vz; : 10/2017

:
Date of Registration / gjpt[ bra;j njjp 28.05.2017

xg;gk; / ××××××
Date of issue / njjp : Signature of Issuing Authority
rhd;wpjH; / mspg;gthpd;
ifbahg;gk;
Seal / Kj;jpiu
No disclosure shall be made of particulars regading the cause of death as entered in the Register
,wg;g[ gjpntl;oy; vGjg;gl;l ,wg;gpd; fhuzk; vita[k; ,g;gFjpapy; btspaplg;glf; TlhJ.
(See Proviso to Section 17 (1) – gphpt[ 17 (1) – d; fhg;g[iuapd;go)