TPAD - apt) HNarvoctdan eogess Qebe,0 e CASTE INCOME [| —_ RESIDENCE Bede, emrchan, varie G8S50 ban SSS) Garin FORM-I FORM OF APPLICATION FOR ISSUE OF COMMUNITY, NATIVITY, INCOME & DATE OF BIRTH CERTIFICATES RELATING TO SCHEDULED CASTE / BACK WARD CLASS UNDER SECTION 3(1) OF ACT OF 1993. {(nformation to be funrnished by the applicant himself support by documentary evidence.) .. Hotéoo ssedepe Hine meg PsshawBs wanw eer TRO OS SeiwwSsowsw, pS Hoss Boowanthity, Soo / Sr SD / S08 Bd ddowdeden,w. mt / a Go88 Sos HoSS,Sswo H008 Adowbabsy,wo. HH GAdAVOw we AMY Hoo / emrctoo / Narwho HOSS Hoare Tadsorsorr SYordubeyeo. DECLARATION 1/ We decalre that the information furnished by me / us in the application is true and correct and document appended there are genuine and the contents of the documents are truie and correct and that if these are found to be untreue and incorrect. | / we will be liable for prosecution for furnishing false and incorrect information / documents under section 10 of the Act No. 16 of 1993. WHPSaag / Horr chns,0. Namo Mandal Father/Husband Name : Revenue Village: Gender Mobile, Date of Birth Caste Door No. aeeeraae Annual income: Street / Vilage ee Residence Since: District Purpose BSHSSHODOO: B.O , SAS sor, eGob sorsDH,0ws5O 6/8m8.. [8893 / ors emmaban / Nand GS SFSw HOH Soden mos Sdgragaresom,6. S60 O80 iso Hycrdsnne d08d00 Derdn Boars. Hoswse ToOswG, AIOB / SIS PHA Sor . Tescaeuss (age hepad omen tape soven BAYS OHMW™E How / emabain / NPdySSFav How Sainow / AWsoowvow Dart, TavsgQso. rd Baia, SEO Voss, ahogs CARDOSUGNVO / DTOOS SHO Senden.