This is to certify that the following information has been taken from the original record of death, which is the register for (local areas)of Tahasilof Districtof State of Orissa.NamePlace of DeathSexPermanent Address of DeceasedDate of DeathRegistration No.Date of RegistrationSignature of Issuing AuthoritySealFORM NO .9(See Rule 8)APPLY FOR DEATH CERTIFICATE(Issued under Section 17)DateName of Father /Mother/HusbandHousing & Urban Development DepartmentGovernment of Orissa Published on National Portal of India (india.gov.in)
