1. INDIA NON JUDICIAL
Government of Karnataka
e-Stamp
$dlrFt Gmit
Certificate No.
1N-KA76173570988241L
Cert iicate lssued Date
13-Nov-2013 03:22 PM
Account Reierence
NONACC (Fl)/ kaksfcloS/ BHADBAVATI/ KA'Sl,4
Unique Doc. Beierence
SUBJN.KAKAKSFCLOSl 1 97702991
Purchased by
P V RAMAKRISHNAIAH
Description of Documenl
Article 4 Affidavil
Description
AFFIDAVIT
Consideration Price (Bs-)
0
F rsl Party
P V RAMAKRISHNAIAH
Second Party
NA
Stamp Duty Paid By
P V RAMAKBISHNAIAH
Slamp Duly Amounl(Rs.)
20
lzerc)
(Twenly only)
."-,--
--_
--. --. --_.P eate wr te or type be ow th
st
ne--
51
43L

2. AFFIDAVIT
I P.V.RAMAKRISHNAIAH S/o V.VENI<ATAPPA residing at the address given below'
K.H.B.8iiB, Golden Jubilee Colony, Bhadravathi-577301 Solemnly alfirm and state on
oath as lollows::
l) That I have applied fbr a Site constructed by the Karnataka Housing Board under MIG
iategory of lla;aja Project at Mysore of Mysore District. I have accepted the-terms and
conditions contained in your Notificalion No. KH B/DC MCS/Allotment/['otter]'/201 l- I4
is
2) I atljrm that I and my family members are residing in the above noted address And it
a rented house. and paying a monthly rent oflls. 243l-.
3) I afllrm that neither I nor my wife or my minor children own or possess site, house or
flat anywherc in Urban area/MLrnicipalitv ofKarnataka State'
4) I t'uriher reaffirm that I have made my application for allotment ofSite under MIG'
5) ! further reaffirm that no house or site has been allotted to me or-to my wile by the
Kamataka Housing Board or any Authority in the state ofKarnataka'
statemcnts lhat Ihave made in my application and in this ailldavit is tbund
t; be in;orrect. the Karnataka Housing Board shall be at lull liberly 1() reject thc application
oi cancel the allotment and resume the property.
6)
Ilany;lthe
Si{nrture of lhe Applicant
fs. Ro-r,,:a.k' *"
Place: Bhadravathi
Date: l3-il-2013
NOl ARISEO AT BHADRAVATHI.
BEFCRE I.'';
HOBHA
Bhadravf
Date :
No.ofcoRREcftoNs
/&M'
g!-:t
t'oh