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c6ogg s{f, KERAT-A FORM No.5
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GovERNi,tENT oF KERALA
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DEPARTMENT oF PANCHAYATs
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Name oE loaal bcdy rssurng certrficate (andartaor Grama panchayat
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t aoou rud5l"r1.oog'
DEATH CERTIFICATE

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'I >r:. ilon l/ OI tne HfJ:Srf ar'On.,f g.r,ts .:-il Dea'-l . ,^(i!, it5._j .tnil R:l;r. 1l
oi the Registtaticn cf ilrrrha an(l Da.rths RirLes, _ 9:.j9)
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foflor..rns :nforma(ron has been raken from rhc oflgrnar recotd sf


l::,: P::1i:-Tidhg for Nsndatloor Gr,alna panchayat (tocat areai/tocat bocly) ..
]Jrjl,fj}fr.."Slster
of Distnct Alappuzha of State Kerala.
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: (o]orm, yo.rl ' Sivasudhan
e.!lr5,'Name
GDori loor6Id / Sex : .Jqar.i / Male

L3lo2l20rL
oo6m orlroGil /Date of Death
( Thirteen / February / Two Thousand Eleven

,ro6m .ru-coJo /Place of Oeath

I Pappu (Father)

.Panackava hil,Kandalloorsouth,Kandalloor PO ,
Address of the deceased at the 'Alappuzha -69o535,India
xol2J al.\ ro, b)s rnrolo)Ct)
c ol.r]ilelc{n l ro).riaoorsoo(Jioi.a q$ 60o\rd..).6rERlld.o'lIrr-J; d-")' )d .)t )'l
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a,qlgg'l.cScqlr.ca'og'-Goo5l5

Karthrke
Permanent address of deceased Panackavadakkathil, Kandalloorsouth,Kandalloor,Kandalloor'
paUy,Alappuzha, Kerala-69053 5
oBlo;cts"&!(d .Drrud/ i 27l21ll o&]fiiicts.or.d o)l1)Dl,' i o4/o3l2cll
Regrstratron No Date of Regrstratron
.rDel(n irodrololti/Remarks (if anv)

Js/',03l2011
.noJ6), .T|T,I u l)-1 Dite of lssue
.r)o.d,lfin (ro(r)l6,3olior:os oql /'

Paqe 2 ol 2
I r Ot2lT(d Aa l,lj',)loorrd po^llololoroldl'
-,-tf Gol &to)iD.rl5 .Io6rDOi,
GOVERNMENT OF KERALA
KqNDAI I UR VII I-AGE OFFICE
POSSESSION CERTIFICATE

No. 63561580 Oate: 2 OA2O22

Name of Person to whom cenific€te


SIVASUTHAN AND REMANI
is issued

Name of Father PAPPU

PANACKA VADAKKATHIL, O, KANDALLOOR


Address
SOUTH

Post Offce with PIN Code KANDALLOOR P O, 690535


District Alappuzha

Certified that land shown in the schedule b€low are in possession and onioyment of ths person

Old Survey Re.Survey ReSurvey Extend Thandapper Class


Taluk / Village
No Block No in Ha of Land

Karthikappally/ Kandallur 19 722110 0.0430 1


'1546 DRY

Karthikappally/ Kandallur 19 723t18-2 0.0690 1 1 546 WET

Certiticate lssued Oate 25t02t2022


Designation of the lssuing ofiicer Village officer
Purpose for which ihe certificate is issued for
KANDALLOOR PANCHAYATH

b assued b6€d dl ole detals git/€n in the apdicathn. local emtiry,


This cenifcat€ f6cLB ard
recqds produced.

Seqrnty Code : 9V3GD

I'OTE:

l. Tlis d{italy sillnd doornEnt b l€gdly veld as per UE lntorrhziim Tednology (ff) A4 2tm.
2. Authedicity d his d@.tnont c l b€ vsified fro.fl hflp:/e&[iclkq-ala.gov.irv dx, sraninhg Ule C€difceie tfunt€a ard
S€drity c.do Altsflati , d€ae cd th€ numbers 15530o(llgn ESt{- brnliie), 04711553m(frun BSl\lL rrl6ile),
o471233552304712115og4trl,7121IsOSE(frsn oh€. nc{u,o*s) arld qrrote l}re Co.lificatc ]&mbo. to lhe opsrahr.
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