This document is a template for a revenue officer to submit an enquiry report to the Tahsildar when an applicant requests a family member or proper person certificate. The template includes sections for the applicant's name and address, the deceased's name and details, a list of family members, the purpose of the certificate, any evidence provided like death or ration cards, and a recommendation from the revenue inspector. It is dated March 3, 2014.

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STATEMENT OF THE VILLAGE REVENUE OFFICER…………………………………….
MANDAL LUXETTIPET, DIST: ADILABAD.
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ENQURY REPORT SUBMITTED TO THE TAHSILDAR, LUXETTIPET
(Proposals for issuing family Members Certificate/ Proper person Certificate)
By Mandal/Revenue Inspector:
Name of the MRI :
1. Name of the Applicant :
2. Address of Applicant :
Door No. :
Building Name :
Street Name :
Village / Ward :
3. Name of the deceased :
4. Relationship of with deceased:
5. Date of death :
6. Place of Birth :
7. Details of family members :
Sl.No. Name of the Family
Member
Age Sex Relationship
8. Purpose for which the certificate is needed :
9. Whether Notary Affidavit is filed or not :
10. Details of evidences produced : 1.Death Certificate Yes/No
2.Ration Card
Yes/No

3. 11. Recommendation of the enquiry Officer:
Date: Signature
Place: Name of the Revenue Inspector