clnsmd~cao clnagdsld aa"~.z3m" mmd 24-d olmdacy 3 17 3 ; 3 o 1 m m m l d a ~ g 59.70 m d clr~ru'cd,~clnd oapoda~g~clrm~mm~m3m 0 \ , &, m d clrCru'm~mJd

m3mm1d~clrmlm m -A, @-A, m d & b d g m m m i ~ ~ s rma@d&~ldamd .

m a d & % &&%Im3m o n - 4 , w u 3rc r )~ ,~~mm3cd & d m 4 7

clrd&m3ml mdccy 3 1 ,/3e 3 o mmm I d a y g clrmimnn~clrld clrls~clrd ~ ~ s ~ o a a m k l n l m ~

m ~ n m l ~ ~ c l r c a ~ m m ~ ~ , clnsa-m~mo ~cn~mdm~~mmmi ld mlmjo 7 2 2 - 3 o mmd 2 s l s ~ ~ 2 njol

crrras~mg ~clram~spjs1a-u m l s ~ m l d a m l ~ ~ ~ ~ m ~ o m&~mj, sl clrmSm1 olmdacy 1d&3m0 ~n~hn~:

CIlISCIC LIST E PREPARED DURING L'ROCESSING OF APYLICATION UNDER --- KERALA LAND ASSIGNMENT RULES 1964

3) Address in fill1

3) Age & Occupation of the applicant

-1 I \I i:~\~l!t.~. :Ilc applicant belongs t o SCIST or Ex.service

5) Whether married or not if married application shall be jointly made

,. v. .. .,) !;.:I;I!I.: rri'ti~r. Cami!y ~nembcrs q a . GI -94 .4o

na~ne,age,occupation, relationship with the applicant an om\-,, 1 7 ) Whether the applicant or any member of his family

have avoid assignment Govt land earlier? If so details there o f

8) Annual family income from all sources

J , I o ~ : ~ i C A i C l l t 0 1 ' I;LIKI l i~ ld by tlle applicant(S) and 1amily . 10) Whether the applicant (S) islare native of Kerala?If not,

date from which residing in the slate

PART I1 DETAILS OF LAND 1 I ) Ueta~ls o f land sought to be assigned Dist..Taluk,Village

3u1\ u j & sub drv no. 13x1. o f land & Nature oi'land Boundaries of north. East G - -L+!.e Y O ~ l l l l

3.0 631M 1

-.v' L

West k9 4 3 T 12) Whethre the land under possesslon & enjoyment of theapplicant (S)

or f : ~ ~ i i i l ~ 0 *

I I'so the date li-om wliich occupied 13) Authoritylrecord produced in proof of occupation and enjoyment

Ration cardlID1ROR or Residence Certificate from LSG I4,iWllel.Iicr trees1 lanls on theyand is7lantec.I by the iipplicanl(S) or

predece P

15) Details of i~nprovements effected in the land by the ~ppIic;lnl(s) predecessors

16) Whether the land is comprised in PanchayatIMunicipality Corporation

17) Cawgory of land as per settlement register

18) Whether the land is that exempted from assignment (viclc S L I I L " 2) *

19) Whether the land is included in the list of assignablelands

20) Details of reserved trees if any standing on the land

21 ) Details of royal trees,if any standing on the land

3fli I'l-e~aili~lg L)!' market value of the land

23) Details of docu~nentd verified to arrive at the market Value of the land

24) LVI:ethcr he applicant is eligible for no~ninal value under rule 6(1) or exempted from payment of land value if so details of there of

5 ) 1 1 ~ h c ilsbignment is under rule 6(2) specify the value of land Improvements etc.

26) Whether the land is under unauthorised occupation? If so details ol'prohibitory assessmenttrent that hai been assessed and delnant notice issued

27) Whether any civil suit is pending againt the assignment of land

PART 111-P UKPOSE *

28) Purpose for which land is applied for house site/benificial enjoyment etc

29) Whether the land is likely to. be needed in tlie ~ L I ~ L I ~ C for any public purpose

30) Whether the remarks of the authorities of PWDIIrrigationI I),,rl ~ ~ ~ , ~ ~ I \ L , I ~ S I ~ ~ I ~ ~ C ~ I ~ ~ I P O I ~ ~ ~ etc; neecled be required

3 I ) Whclher any deposits of valuable mines and minerals noticed in the land.

32) Whether is vested with LSG

33) Whether a sketch and group sketch of land is prepared and appended

Place: Date :

Fead of Account :

DDO Code : (Dept.)

5" SDO Code : 1 Q \ -.--

By Whom patd and

~~t=zae~96 1 1 - 1 Receive

'

,

........................ Total in words ..&J.-.-.. .@?G?. I

and : gr?nt

receipt

Treasurv Signature & Designat~on of the Departmental Off~cer counters~gning the remittance

Sigcature

Received

(Rupees

. . . . . . . . . . . . . . .

Date ......

Total

, Signature

of Remitter.

R s. ............

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

...............................

. . . I . . . . . . . . . I . ...... .:

of Treasurer/C

I

I-

Note: I

1 The sealistamp of the Tre ectlon shall be aff xed I 2 If remittance is in off~cial DO), write corresponding I

code in the column 3. If loan repayment o

I t number in purpose column. 1

Officer

GPV. 25/08/2006. 5 lakhs -