సంఖ 1

ఆంధ పే పభుతము

No. 1
ారం-6
GOVERNMENT OF ANDHRA PRADESH FORM-6
ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

GRAMA PANCHAYAT RODDAM

మరణ ధృవ పతము

DEATH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION OF
BIRTHS & DEATHS RULES 1999.)

ఈ ింి సమాా మరణం నదు క అసలు ిారు ాషం క... ామ పంాయ ొదం . ొడంలా .. అనంతప ాలూా / బా ుంి సుోబింి అ సరిౖ
ేయడం
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR
GRAMA PANCHAYAT RODDAM OF TAHSIL/BLOCK RODDAM OF DISTRICT ANANTAPUR OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

మరణింన వి రు / NAME OF DECEASED : K PEDDA VENKATAPPA ంగము / SEX: पुरुष / MALE

ఆా సంఖ / AADHAAR NO.:

XXXXXXXX1624

మరణింన ేి / DATE OF DEATH: మరణింన పేశం / PLACE OF DEATH:

12-02-2020 4-25, CHINNA KODIPALLI, CHINN KODIPALLI, RODDAM, RODDAM,
TWELFTH-FEBRUARY-TWO THOUSAND TWENTY ANANTAPUR, ANDHRA PRADESH, 515123.

భర / ర రు / NAME OF HUSBAND / WIFE:

మరణింన వి క వయసు / AGE OF DECEASED: K SANNAMMA
74 YEARS
ఆా సంఖ / HUSBAND/WIFE AADHAAR NO. :

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER :

K ENKAPPA

ఆా సంఖ / MOTHER'S AADHAAR NO. : ఆా సంఖ / FATHER'S AADHAAR NO. :

మరణింనపడు మృతు రుామ / ADDRESS OF THE DECEASED AT THE TIME OF మృతు ిరాసప రుామ / PERMANENT ADDRESS OF DECEASED :
DEATH :
4-25, CHINNA KODIPALLI,
4-25, CHINNA KODIPALLI, RODDAM, RODDAM, ANANTAPUR,
RODDAM, RODDAM, ANANTAPUR, ANDHRA PRADESH- 515123
ANDHRA PRADESH- 515123

నదు సంఖ / REGISTRATION NO: నదు ేీ / DATE OF REGISTRATION:

D-2020: 28-11179-000004 29-02-2020

ేాంశములు / REMARKS (IF ANY):

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ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY
29-02-2020
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)

GRAMA PANCHAYAT RODDAM

UPDATED ON :
29-02-2020 08:27:33

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.
" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "