सं.

1
No. 1
उर देश सरकार प-6
GOVERNMENT OF UTTAR PRADESH FORM-6
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

मृयु माण-प
DEATH CERTIFICATE

(जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002.)

यह मािणत कया जाता है ननलिखत सूचना मृयु के मूल अभलेख से ल गई है जो क ाम पंचायत फतेहनगर करसीमा तहसील फतेहपुर िजला फतेहपुर
राय/संघ देश उर देश,भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER
FOR GRAMA PANCHAYAT FATEHNAGAR KARSUMA OF TAHSIL/BLOCK FATEHPUR OF DISTRICT FATEHPUR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : CHHEDDU लंग / SEX: पुरष / MALE

मृयु क तथ / DATE OF DEATH: मृयु का थान / PLACE OF DEATH:

25-11-2022 FATEHNAGAR KARSUMA, CHURIYANI, FATEHNAGAR KARSABHA,
TWENTY-FIFTH-NOVEMBER-TWO THOUSAND TWENTY TWO FATEHPUR, FATEHPUR, UTTAR PRADESH, 212601.

पत / पी का नाम / NAME OF HUSBAND / WIFE:

मृतक क उ / AGE OF DECEASED: RAMA DEVI
68 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER :

DHANDHU

आधार नंबर / MOTHER'S AADHAAR NO. : आधार नंबर / FATHER'S AADHAAR NO. :

मृयु के समय मृतक का पता / ADDRESS OF THE DECEASED AT THE TIME OF मृतक का थायी पता / PERMANENT ADDRESS OF DECEASED :
DEATH :
FATEHNAGAR KARSUMA,
FATEHNAGAR KARSUMA, CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR,
CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR, UTTAR PRADESH- 212601
UTTAR PRADESH- 212601

पंजीकरण संया / REGISTRATION NO: पंजीकरण तारख / DATE OF REGISTRATION:

D-2022: 9-25560-000019 10-12-2022

टपणी / REMARKS (IF ANY):

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जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
10-12-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

UPDATED ON :
10-12-2022 12:04:10

"THIS IS A COMPUTER GENERATED CERTIFICATE. "

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.
" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "