థ෩ච§± Form - 6

ఒකბజఒళ౽ბబ

GOVERNMENT OF KARNATAKA

ఙథథపൡ౨పబఠఔయ෨ఓ౲ඣైంణ൏ඌ౽คఔำ
Chief Registrar of Births and Deaths
పబఠద౳෥ఠదడ౳
‡ఙపඣైఄඌඛఫప¬´±´బ¬­Ž¬²ඡఫద౳ఒబఠ๻ಟఒఙపඣైඛఫపఔำ~
¬´´´బඛఫప³Ž¬®బ෬ฉಡಆఞมణˆ
DEATH CERTIFICATE
(Issued under Section 12/17 of the RBD Act, 1969 and Rule 8/13 of the KRBD Rules, 1999)

7l_B2NĻ`\žl[UhÇB£eLBªeIÍSĻI[UD\ĝ¬lÐ[BiNÐĖŸe^iÐĔUdhœls2 ’eÎZVL¾P Sĸĝc¾ĸUĹÐ\h`Z\Pc2X2T®eSZi^

¡eC¬lĵ2SŸl’lShli_ѬeĖ¡lĶ2ShVΨeĥsBĸc¬eĖ¡l

This is to certify that the following information has been taken from the original record of death which is the register for Hudem
(village/town) of Kudligi taluk of VIJAYANAGARA district of Karnataka State
 ²lc\h XcZÌ  ĹxD ²lPhÂ
Name BASAMMA Sex Female
 Z\PSĨ£exB 28/03/1979  Z\PScÄ_
Date of Death Place of Death
THAYAKANAHALLI, Hudem,Kudligi
,VIJAYANAGARA,Karnataka
 Ÿeĵ[²lc\h  Qx¡l[²lc\h
Name of Mother NO INFORMATION Name of the Father NO INFORMATION
 DxNU²l2NĦ[²lc\h D2DVÈ5Ĺ©eŤV†—eĸD2DVÈ
Name of the Husband/Wife GANGAPPA ALIYAS POOJARI GANGAPPA
 Z\PScZ[SĹÐZjQ\Ļ­ec  ZjQ\‘e[xĻ­ec

THAYAKANA HALLI, BiNÐĖĻI[UD\B£eLB

THAYAKANA HALLI, BiNÐĖĻI[UD\B£eLB

Address of deceased at the time of death: Permanent address of the deceased:

-, -, THAYAKANA HALLI,Kudligi -, -, THAYAKANA HALLI,Kudligi ,VIJAYANAGARA,Karnataka

,VIJAYANAGARA,Karnataka
 £lisxSĥcx‘lÍ 605135/V/D/2023/000034  £lisxSĥŸeĸsCh 05/08/2023
Registration No.: Date of Registration:
 bªe ©e`ƒ¡eT\h6SÅĹÐ  4UhūsS£l[Ĩ£e2B 09/08/2023
Remarks(if any) -crlmisno118/202- Date of Approval
crlmisno118/202
 VΨePVQΐliNh`¤eÎĩeĸ[cĿ  VΨePVQΐliNh`¤eÎĩeĸ[Ļ­ec
Digitally signed certificate, manual signature is not required. Address of the issuing authority Village Accountant
Hudem Circle, Kudligi Taluk, VIJAYANAGARA District

Date of Issue 10/08/2023

³ద౳ൟ෽ంൿఙథథపൡ౨పబఠణඣైంణ൐ఫඝ౬ఓ೉డదല๭ಆั౶
³Ensure registration of every birth and death´
లฃ€పబఠඣైంణ൐ఫඝ౬https://ejanma.karnataka.gov.in ణย౵ඁുైఒค๭ಆั౶
Note : Verify the Death registration at https://ejanma.karnataka.gov.in