FORM No.

III
(See Rule 3)
GOVERNMENT OF ODISHA
Office of the Tahasildar Khariar
Miscellaneous Certificate Case No E-INC/2023/2247041
INCOME CERTIFICATE
(Valid for the Financial Year 2023-2024)

This is to certify that Smt KALPANA CHALAN daughter of Smt PURNAMI BISHI and Shri PRASANNA KUMAR
BISHI, W/o Late SIMANCHAL CHALAN is a native/permanent resident of the district of NUAPADA in the state of
Odisha and she/ her family is presently residing at Village/town KASIPALA P.S KHARIAR Tahasil Khariar in the
district NUAPADA of in the state of Odisha has an annual family income ofRs. 30000.00 (Rupees Thirty Thousand )
only from the sources specified below.
Sl Income(in
Source
No. Rs.)
Agriculture (including plantation, horticulture, dairying, poultry,
1 fisheries etc.)
30000.00

2 Salary/ Wages/ Renumeration etc.

3 Trade/ Business/ Profession (Please Specify)
4 Other Sources(Please Specify) 0.00
Total 30000.00

dgSign2031LocnDyna
Signature of the Revenue
Officer
18/12/2023

**** This is a Digitally Signed Document And Does Not Require Signature ****

NOTE
(i) It is a digitally signed electronically generated certificate and therefore needs no ink-signed signature.
(ii) This Certificate is issued as per section 4, 5,& 6 of Information Technology Act 2000 and its subsequent amendments
in 2008 and as per Revenue & Disaster Management Department Notification number IMU-13/10-4251/R&DM.
(iii) For any Query or Verification , Agency /Department / Office may visit https://edistrict.odisha.gov.in/
(iv) Tampering of this Certificate will attract penal action.

Reference No: E-INC/2023/2247041 To View: https://edistrict.odisha.gov.in/t/Uuhie/95F63D4F Token No: 95F63D4F