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Form No.6
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GOVERNMENT OF TAMIL NADU
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DEPARTMENT OF MURICIPAL, ADRIMISTATION AND WATER GUPPLY
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CCOMDATORE CoNPORATION
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rece neeRSeCHON 1247 OF THE NEOIGTHATON OF HIRING & DCATIS ACT, 1E0 ANO NULE AX OF THE TAMK, NADU
REcISTHATION oF BHT AND DEATH RULES 2000)
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Meee an eyY TAT THE FOLLOWING IFONUATION AS OCC TAKEN THOM THE ONOHAL RECORD OF DEATH W8NCH 5 THE
EOBTENTOR CONPONLATION WARD 35 OF COMDATOR HONTH TALUX OF COMDATONC DISTRICT OF TAMIL HADU STATE, DUA,
NAME OF OLCEASCO! Quy ai) scrum MALE ge
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VONUMOLIROF OF CEASLO Binet aL) eds
OAT OF OCA Ainsbs Cx rS0Kn020—* PLAGE OF DFAT
PeTCEN-APmiLTWO THOUSAND TWENTY KOVAIMCDICAL CLNILIT AND HOSPITAL MUTED,
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AoC OF DECEASIO/ DARN) we YEARS
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NAME OF MOTHER Muu CU)
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saan Wir We ras Hamers Ou FAILS UONO. pang gang oot
Cae iaceeeteniin: HUSOARD WATE UID NO YacHE oem Ags te
AODNLSSOF HE DECEASED AT WIE HME OFOCATH Ce rey)
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2108, DEVANANPALAYAM POST, ,POLLACH, CONMBATONE, TAIL
NADU ea2i20
2106,