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    Adobe Scan 02-Aug-2023 (4)

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    Adobe Scan 02-Aug-2023 (4)

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    3 views1 page

    Adobe Scan 02-Aug-2023 (4)

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    No 1

    GOVERNMENT OF ANDIIRA PRADESIH FORM-6

    DEPARTMENT OF HEALTL MEDIC AND FAMILY WELFARE


    GOVT.GENERAL HOSPITAL,SRIKAKULAM

    DEATII CERTIFICATE

    (SSUED UNDER SECT*ON 12/17 OF THE REGISTRATION OF BIRTHS &DEATHS ACT, 1969 AND RULE B/13 OF THE ANDHRÁ PRADESH REGISTRATION OF
    BIRTHS & DEATHS RULES 1999.)

    THIS IS TO CERTIFY THATTHE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR
    GOVT.GENERAL HOSPITAL,SRIKAKULAM OF TAHSIL/BLOCK SRIKAKULAM OF DISTRICT SRIKAKULAM OF STATE/UNION TERRITORY ANDHRA PRADESH.
    INDIA.

    SdtoodS Ss / NAME OF DECEASED : KARRI TATARAO Ootá SEX: 0000D /MALE


    SP6 Ko) / AADHAAR NO.:
    XXXXXX`159
    otooSZ/DATE OF DEATH: áotods KaÁo |PLACE OF DEATH:
    KS8o woÑ SY ,185°sto /GOVT GENERAL HOSPITALSRIKAKULAM
    03-07-2023
    THIRD-JULY-TWO THOUSAND TWENTY THREE /
    go / O" NAME OF HUSBAND / WIFE:
    KARRI RAMALAXMI
    SóteoDS Ss dos, S / AGE OF DECEASED:
    65 YEARS esÇPÖ Sos HUSBAND/WIFE AADHAAR NO.
    XXXXXXXX7047

    d / NAME OF MOTHER: bo; & / NAME OF FATHER:


    KARRIVALLAMMA KÁRAI APPALASWAMY(LATE)
    es5os / MOTHERS AADHAAR NO. : S 6Soa,s FATHER'S AADHAAR NO. : Hocsc
    `ÖROD3 áá NÍF IADDRESS OF THE DECEASED AT THE TIME á)a rs i |PERMANENT ADDRESS OF DECEASED :
    OF DEATH: BATTIGALLURU, UPPALAM, SOMPETA, SRIKAKULAM, ANDHRA PRADESH
    BATTIGALLURU, UPPALAM, SOMPETA, SRIKAKULAM, ANDHRA PRADESH

    s r d Joas /REGISTRATION NO: 33rá db| DATE OF REGISTRATION:


    D-2023: 28-90163-000824 04-07-2023

    Jroisse/REMARKS (IF ANY):

    oK Sodso / ISSUING AUTHORIIY


    ibs 3o/ DATE OF ISSUE:
    17-07-2023
    RRGISTRAR (BRTIL &DEAT)

    GOVT.GÊNERAL IOSPITAL,SRIKAKULAM

    UPDATED ON
    17-07-2023 05:05:51

    CONTAINS FACSIMILE SIGNATURE OF THEISSUING AUTHORITY"


    wTHIS 1S A COMPUTER CENERATED CERTIFICATE WHICHNO, 1/12/2014-VS(CRS) DATED 27-/ULY-2015 HAS
    THEGOVT. OF INDIA VIDE CIRCULAR FOR ALL OFFICIAL PURPOSES.
    APPROVED THIS CERTIFJCATE ASA VALID LEGAL DOUCMENTREGISTRATION OF EVERY BIRTHAND DEATH*
    Sàr O o / ENSULR:
    b asá), (o áros sSYso 21 Uweî

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