సంఖ 1

No. 1
ఆంధ పే పభుతము ారం-6
GOVERNMENT OF ANDHRA PRADESH FORM-6
ైద,ఆోగ మియు టుంబ సంేమ ాఖ
DEPARTMENT OF HEALTH, MEDICAL AND FAMILY WELFARE

MUNICIPAL CORPORATION ELURU

మరణ ధృవ పతము

DEATH CERTIFICATE

(జనన మరణ నదు చటం 1969, 12/17 గము పారము, ఆంధ పే జనన మరణ నదు బంధనలు 1999, 8/13 ింద ాీేయడైని)

(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE ANDHRA PRADESH REGISTRATION OF BIRTHS &
DEATHS RULES 1999.)

ఈ ింి సమాా మరణం నదు క అసలు ిారు ాషం క... ముిపల ాొేష ఏలూరు . ఏలూరులా .. ఏలూరుాలూా / బా ుంి సుోబింి అ సరిౖ
ేయడం
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR MUNICIPAL
CORPORATION ELURU OF TAHSIL/BLOCK ELURU OF DISTRICT ELURU OF STATE/UNION TERRITORY ANDHRA PRADESH, INDIA.

మరణింన వి రు / NAME OF DECEASED : KALAGARA KAMALA ంగము / SEX: महिला / FEMALE

ఆా సంఖ / AADHAAR NO.:

XXXXXXXX7256

మరణింన ేి / DATE OF DEATH: మరణింన పేశం / PLACE OF DEATH:

18-09-2020 103 , SRI SATYM RESIDENCY RR PETA, ELURU, ELURU, ELURU,
EIGHTEENTH-SEPTEMBER-TWO THOUSAND TWENTY ANDHRA PRADESH, 534002.

భర / ర రు / NAME OF HUSBAND / WIFE:

మరణింన వి క వయసు / AGE OF DECEASED: KALAGARA SURENDRA BENARJI
74 YEARS
ఆా సంఖ / HUSBAND/WIFE AADHAAR NO. :

తలి రు / NAME OF MOTHER: తంి రు / NAME OF FATHER :

ఆా సంఖ / MOTHER'S AADHAAR NO. :

--- ఆా సంఖ / FATHER'S AADHAAR NO. :
---

మరణింనపడు మృతు రుామ / ADDRESS OF THE DECEASED AT THE TIME OF DEATH : మృతు ిరాసప రుామ / PERMANENT ADDRESS OF DECEASED
:
103 ,
SRI SATYM RESIDENCY RR PETA, ELURU, ELURU, WEST GODAVARI, 103,
ANDHRA PRADESH- 534002 SRI SATYM RESIDENCY RR PETA, ELURU, ELURU, WEST GODAVARI,
ANDHRA PRADESH- 534002
నదు సంఖ / REGISTRATION NO: నదు ేీ / DATE OF REGISTRATION:
D-2021: 28-90025-001378 15-09-2021

ేాంశములు / REMARKS (IF ANY):

---

ాీ ేిన ేి / DATE OF ISSUE: ాి ేిన అిాి సంతకం / ISSUING AUTHORITY
10-07-2023
(జనన మరణ ిషా)
REGISTRAR (BIRTH & DEATH)
MUNICIPAL CORPORATION ELURU

UPDATED ON :
2021-09-15 10:09:11

"THIS IS A COMPUTER GENERATED CERTIFICATE WHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
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.

" ప జననము, ప మరణము తపంా 21 ోలలో నదు ేయంి" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "