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FORM No.6
Boorr€P 15q$t55u ilt Nffi[
GOVERNMf, NT OF TEI-AXGANA
DI]PARTMENT OF MIINICIPAL ADMIMSTRATION
553edil6q9
MEDICAL & I{EALTE DEPAXTMENT
Js6o Sg $1rl5r
DEATH CERTIT'ICATE
certi{lcrte ld: 160}I>3883
aSJ lo6.n JBrdo '5Q$) 1969,12117 iaffifu Grrdio) 6c)0rr.r aJJ XDdr, ,SarCo iaodJe))
1999,8/13 3aol5,$ Llod a6
"3<$a6,ia.
(I55{.d urdGr SEtlon E/17 of tnc rcgEtrallon ot Blrtlr. .rld tLaltr 4C.1959 and Rst€d a/13
of.di! f.Ln!|.na RcgLdratlon ot atrthr:n.t DG.tk Rule. 1999)
Sooo'E ' o't+J)) 3Q=ro deir 6oar')t 06i.o'5 6o*uo ( AS L5d{5)) lo6E 6r+,5
dlJo56.aS 6cao6ooJ (,$cx Os-qr $oa,Lso6 i)Jrd6JD 3i!s.5aa.s6i
6J55oodd&,$6.
This is to certjfy that the following information has be€n taken ftom the originat record of
death which is in the r€qister for(local area ./ locll body) DUBBAX rUiICIPALITY OF
STDDIPET DISTRICT OF STATE OF TEI'I'GAIIA

li&Gb.s d6 / oate or De6t 11l06lzOAt

(DD/A|H,.rrW) O'G EOUR ZEXI) !iD(.'TTO ERO THREE
lD6doai5 L56di! / Ple of o6th 'WO to2t('
ia a-2s-LlocEy oollLl( slDDtpEt
gQ a6r / xare ot l.io$Er PARSA RA.,AWA
6olar'd0 a6 / tl.m€ ofthe
P RSA St{AtiX RA|Atl
$.f,roanildr $)doA OdrJllo /
Lldl!$ o{ the O*aed at tlE tme of Dt,gEAK DUTAA( SIDOIPEI

5ra6i a6.iilia OdDs'5, / E.25 (ACIiAPET OUAAA( STOOIPET

t€tffilgt Addra of lre Deceas€d
,i3rt5) iro+Y ReqaiEtim lumb€t 7'
i3d$ d6/ Date of RegisrEtioo 2r 106lro23
(oo/r,tlfiYrY)

,16 db,i t6 / Er.te of rssue

6/O7 t20Aa
(oo/M M,/WYY)

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DI'BIA( !.UI'ICTPAt.TY
D.t I atolo1l2oz3
SIDOIPEI OI!iTiICT

Lotc : Tnk 6 Oigh.lly Signed Certifiete, d@s not r.qui€ phy.ic.l si96.bre. And this certirl@re on b€ vertl'r€d at
hths://ts.me4va,telan$na.9ov.inl by turnishinq the appliQtion numbcr nrentioned in the C€rtin@te.