FORM NO. 61 ( See proviso to clause (a) of Rule 114C ) 1. Full Name And Address of the Declarant 2. Particulars of the transaction Date : Place : Signature of the Declarant VERIFICATION I, do hereby declare that what is stated Name and Signature FORM OF DECLARATION FOR PERSON WHO HAS AGRICULTURE INCOME Government of Orissa Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) or Rule 114B 3. Details of the documents being produced in support of address in column (1) : Yes No I hereby declare that my source of income is from agriculture and I am not required to pay income-tax on any other income,if any. Date : Place : INSTRUCTIONS Documents which can be produced in support of the address are :- Ration card Passport Driving license Identity card issued by any institution Copy of the electricity bill or telephone bill showing residential address or local bodies showing residential address Any document or communication issued by any authority of Central Government, State Government Any other documentary evidence in support of his address given in the declaration. above above is true to the best of my knowledge and belief. Verified today, the day of Agriculture Dapartment Published on National Portal of India (india.gov.in)
