ama TTT YY Aadhar Number I Fromaatets Dated Qe Tow, Mamlatdan 41d, Ofice of the Mamlatd imei 62, Dis da: Subject: Application forse of Residence Certicate Rove wars yaurrer Aaa 2d oA WIE sib, ilok Applicat peeled eit - 2 | Binh Pace and Di Date SEES pom Bak BAA ALL S| Oseuption AC “| Name of the head of the Foose Fol ‘which he pint reside! RELA, size gun ouieaah ol | Maried! Uamemrid walsivenaiota Puce of residence ca Name of few Neola [Howe Nod ae otsie House Test ete Wags) ‘doses. |__| aster 36 woud 8 AA Rote TW] Nan of vile paachava Aedtaavooraesteg oA TH |The period of esideneeof pace when ie applicant resifence atthe above refered paces oneal Boe wath Goze aeou a B Ac Move 1 The ple of Reidenoe prior the Plas oF residence as indicted nove in case ‘pliant was nt sing continuously at theabove given adress } Jawente’ Seat Gus azeur 2a 1 AM al HL A AHA HIM, Rout 1S | it employes where eplyed daring We Ise monte Beas alder alla seat Aw saa TH | in business the place of bars Gorn the let 6 month Beal = lat A Seat BHA ig,[i] eet pace ofa drag te] Tas mc (oue ofthe aston standard in which studying)! % UL JSxa Bear e abou aun, Bividk Aa A BUNg| ta viel ATL pe Relatioasip ofthe application with tie ‘Head of Household wih wher shal he! sheresides/ ORE, BL ALE aa ast 7 ‘Whether the appli anes ncading inthe Raton Card ofthis re a the Elen! Rel ine fists neat ater AER tl ots Sulal aa a Beh ve ‘What ti oppian as any Tanovable property of herein the pce of esidece nds give denis. eet. ATA ister au et te Pape fOr WHEY Hi ena ‘ete ie egured and before whom i iebe prosicess SADEUA tea yatewta St By Ale WAY 56 SoMa B Stag, © ach Rove Pleo 8 Dia Ot Dated ote arene a Signator of Appi