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Uttar Pradesh Death Certificate Form

This document is a death certificate from the Grama Panchayat Fatehnagar Karsuma in Uttar Pradesh, India. It certifies the death of Chheddu, a 68-year old male who died on November 25th, 2022 in Fatehnagar Karsuma. The certificate provides details of the deceased such as name, age, address, names of parents, date of registration, and was issued on December 10th, 2022 by the Registrar of Births and Deaths of the Grama Panchayat Fatehnagar Karsuma.

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Divyansh Singh 11A
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1K views1 page

Uttar Pradesh Death Certificate Form

This document is a death certificate from the Grama Panchayat Fatehnagar Karsuma in Uttar Pradesh, India. It certifies the death of Chheddu, a 68-year old male who died on November 25th, 2022 in Fatehnagar Karsuma. The certificate provides details of the deceased such as name, age, address, names of parents, date of registration, and was issued on December 10th, 2022 by the Registrar of Births and Deaths of the Grama Panchayat Fatehnagar Karsuma.

Uploaded by

Divyansh Singh 11A
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

सं.

1
No. 1
उर देश सरकार प-6
GOVERNMENT OF UTTAR PRADESH FORM-6
चकसा एवं वाय वभाग
DEPARTMENT OF MEDICAL AND HEALTH
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

मृयु माण-प
DEATH CERTIFICATE

(जम मृयु रिजकरण अधनयम , 1969 क धारा 12 / 17 तथा उर देश जम मृयु रिजकरण नयम, 2002 के नयम 8/13 के अंतगत जार कया
गया )
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE UTTAR PRADESH
REGISTRATION OF BIRTHS & DEATHS RULES 2002.)

यह मािणत कया जाता है ननलिखत सूचना मृयु के मूल अभलेख से ल गई है जो क ाम पंचायत फतेहनगर करसीमा तहसील फतेहपुर िजला फतेहपुर
राय/संघ देश उर देश,भारत के रिजटर म उिलिखत है ।
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORIGINAL RECORD OF DEATH WHICH IS THE REGISTER
FOR GRAMA PANCHAYAT FATEHNAGAR KARSUMA OF TAHSIL/BLOCK FATEHPUR OF DISTRICT FATEHPUR OF STATE/UNION TERRITORY UTTAR
PRADESH, INDIA.

मृतक का नाम / NAME OF DECEASED : CHHEDDU लंग / SEX: पुरष / MALE

मृयु क तथ / DATE OF DEATH: मृयु का थान / PLACE OF DEATH:


25-11-2022 FATEHNAGAR KARSUMA, CHURIYANI, FATEHNAGAR KARSABHA,
TWENTY-FIFTH-NOVEMBER-TWO THOUSAND TWENTY TWO FATEHPUR, FATEHPUR, UTTAR PRADESH, 212601.

पत / पी का नाम / NAME OF HUSBAND / WIFE:


मृतक क उ / AGE OF DECEASED: RAMA DEVI
68 YEARS
आधार नंबर / HUSBAND/WIFE AADHAAR NO. :

माता का नाम / NAME OF MOTHER: पता का नाम / NAME OF FATHER :


DHANDHU

आधार नंबर / MOTHER'S AADHAAR NO. : आधार नंबर / FATHER'S AADHAAR NO. :

मृयु के समय मृतक का पता / ADDRESS OF THE DECEASED AT THE TIME OF मृतक का थायी पता / PERMANENT ADDRESS OF DECEASED :
DEATH :
FATEHNAGAR KARSUMA,
FATEHNAGAR KARSUMA, CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR,
CHURIYANI, BALIPUR, FATEHPUR, FATEHPUR, UTTAR PRADESH- 212601
UTTAR PRADESH- 212601

पंजीकरण संया / REGISTRATION NO: पंजीकरण तारख / DATE OF REGISTRATION:


D-2022: 9-25560-000019 10-12-2022

टपणी / REMARKS (IF ANY):


---

जार करने क तथ / DATE OF ISSUE: जार करने वाला ाधकार / ISSUING AUTHORITY
10-12-2022
रिजार (जम एवं मृयु)
REGISTRAR (BIRTH & DEATH)
ाम पंचायत फतेहनगर करसीमा
GRAMA PANCHAYAT FATEHNAGAR KARSUMA

UPDATED ON :
10-12-2022 [Link]

"THIS IS A COMPUTER GENERATED CERTIFICATE. "


THE GOVT. OF INDIA VIDE CIRCULAR NO. 1/12/2014-VS(CRS) DATED 27-JULY-2015 HAS
APPROVED THIS CERTIFICATE AS A VALID LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES.
" येक जम एवं मृयु का पंजीकरण सुनचत कर" / ENSURE REGISTRATION OF EVERY BIRTH AND DEATH "

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