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This is to certify that the following information has been taken from the original record of death which is the register for Chickbevanur
(village/town) of Indi taluk of Vijayapura district of Karnataka State
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Name SIDDAPPA MALAGAR Sex Male
Z\PSĨ£exB 07/08/2018 Z\PScÄ_
Date of Death Place of Death
Chikkabevanur, Chickbevanur,Indi,Vijayapura,Karnataka
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Name of Mother KALLAVVA Name of the Father REVAPPA
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Name of the Husband/Wife BHAGIRATHI
Z\PScZ[SĹÐZjQ\Ļ­ec ZjQ\‘e[xĻ­ec

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Address of deceased at the time of death: Permanent address of the deceased:

Chikkabevanur, Chikkabevanur ,
Chickbevanur,Indi,Vijayapura,Karnataka Chickbevanur,Indi,Vijayapura,Karnataka
£lisxSĥcx‘lÍ 599255/V/D/2018/000023 £lisxSĥŸeĸsCh 13/08/2018
Registration No.: Date of Registration:
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©e`ƒ¡eT\h6SÅĹÐ VΨePVQÎĪsģSĨ£exB 20/08/2018
Remarks(if any) Date of Issue
VΨePVQΐliNh`¤eÎĩeĸ[cĿ VΨePVQΐliNh`¤eÎĩeĸ[Ļ­ec
Signature of Issuing Authority Address of the issuing authority Village Accountant
Chikkabevanur Circle, Indi Taluk, Vijayapura District

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