Burial Ground wtchman tchiman

Anakapalli (2one) G.V.M.C.

9 .
Date. o t s e s e e a d s n e8 e a e n e n e n
 Book No.
11 SI.No
TRIPLICATE
17492
GREATER VISAKHAPATNAM MUNICIPAL
AAMAAAUNIC
o
CORPORATION
CREMATION &BURIAL GROUND REPORT
DEATH INFORMATION
(to be filled by the informate)

1. Deceased Name

2. Date of Death

3. Age and Sex 67 lansa Lc

4 Father/Husband Name l _ Sfl
5 Mother Name s s 2L
6. Name of Husband/Wife
7. Place of Death
8. Residential address ONO: l 0 I TAp.cza
at the time of Death Sso Qme
9. Permanent Address
10. Cause of Death
11. Informate Name
Address DnO
yYhskapatn.can
. 78428. 183SC
SIGNATURE
Date of Cremation /Burial: 17.6-2c2)
Burial Ground)
(To be filled by Incharge of the
17492Apskapall:(om.)
Registration of Ward/Zone:
GroundnolkhuSmonma a
Name of the Burial
Address:Sonaclha BaicgeAnkaylall:Cte

Date of Burial/Cremation:7-G
Qga
KSSaiNdV
Incharge
Singature of the
of fhe Rurial Ground