Receipt of House Rent

Received a sum of Rs.___________________________________ (Rupees ________

__________________________________________________________ towards the

rent for the month of ____________________ in respect of House No.____________

situated at ____________________________________________________________

_____________________________________________________________________

(Affix Revenue Stamp of Re.1/-)

Signature of the House Owner

Date:

Name, Address & PAN of the House Owner

_____________________________________

_____________________________________

_________________________________________

_________________________________________