No 1

GOVERNMENT OF ANDHRA PRADESH FORM-6

foF HEALTH, MEDICAL AND FAMILY WELFARE

MUNICIPAL CORPORATION ANANTAPUR

DEATH CÉRTIFICATE

ISSUED UNDER SECTION 12//7 0F THE REGISTRATION OF BIRTHS &DEATHS ACr, 1969 AND RULE 8/13 OP THE ANDHRA PRADESH REGISTRATION OF BIRTHS &
DEATHS RULES 1999.)

THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICHIS THE REGISTER FOR MUNICIPAL.
cORPORATION ANANTAPUROF TAHSIL/BLOCK ANANTAPUR OF DISTRICT ANANTAPUR OF STATE/UNION TERRITORY ANDHRA PRADESH, INDLA.
Sobo ás / NAME OF DECEASED: CCHERUKUTHOTA RAMAKKA Dosáu | SEX: 00000 / FEMALE
ssos AADRAAR NO.:
XXXXXXOXX9034

ydroOs Ja/ DATE OF DEATH: Sodteods Höbo /PLACE OF DEATH:

04-11-2020 27-671,AMBEDKAR NAGAR, ANANTAPUR, ANANTAPUR, ANANTAPUR,
FOURTH-NOVEMBER-TWO THOUSAND TWENTY ANDHRA PRADESH, 515001.
30 /Ðs"J) 7 NAME OF HUSBAND / WIFE:
Sdods St ns Sabá/AGE OF DECEASED: CHERUKUTHOTA NAGANNA
65 YEARS
es6 soa / HUSBAND/WIFE AADHAAR NO. :

s / NAME OF MOTHER S o t /NAME OF FATHER:

C PULLAKKA

es6 soa / MOTHERS AADHAAR NO. :

eP So; / FATHER'S AADHAAR NO. :

Jcboa ydoo Ddi /ADDRESS OF THE DECEASED AT THETIME OF DEATH: ydN OH DNÍ PERMANENT ADDRESS OF DECEASED
27-671, AMBEDKAR NAGAR, 27-671, AMBEDKAR NAGAR,
ANANTAPUR, ANANTAPUR, ANANTAPUR, ANANTAPUR, ANANTAPUR, ANANTAPUR,
ANDHRA PRADESH- 515001 ANDHRA PRADESH- 515001

spd s o /REGISTRATION NO: 3I Ib/DATE OF REGISTRATION:

D-2020: 28-90072-001999 17-11-2020

Sotáww/REMARKS (IP ANY):

s db/ DATE OF ISSUE: JOS eSt So`Bo / ISSUING AUTHORITY

17-11-2020

REGISTRAR (BIRH &DE AJH)

MUNICIPAL CORPORAIIx AN INI 4

UPDATED ON:
2020-11-17 12:24:04

THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
THE GOVT. OF INDLA VIDE CIRCULAR NO. 1/12/2014-VS(CRS)DATED 27-/0LY-2015 HAS
APPROVED THIS CERTIFICATE AS AVALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.
*p aSS sndaso 3 o c 21 Gero 33rá Sabo ENSRE REGISTRATION OFEVERY BIRTH AND DEATH"