The document is a receipt for house rent received under Section 1(13-A) of the Income Tax Act. It states that a sum of money in words was received towards rent at a certain rate per month from one date to another date. The rent was received from a named person for premises at a specified address belonging to a named house owner as evidenced by their signature.

1. RECEIPT OF HOUSE RENT
(Under Section 1 (13-A) of Income Tax Act)
Received a sum of Rs. _____________ (in Words ___________________________________)
Towards the rent @____________per month from _______________ to __________________
Received from Mr. / Ms. / Mrs. ______________________________________________
towards rent of the Premises as mentioned in the below address.
Name & Address of the House Owner (Affix Revenue Stamp of Rs.1/-)
Name: ______________________
Address:_____________________
______________________________
______________________________ Signature of the House Owner
RECEIPT OF HOUSE RENT
(Under Section 1 (13-A) of Income Tax Act)
Received a sum of Rs. _____________ (in Words ___________________________________)
Towards the rent @____________per month from _______________to __________________
Received from Mr. / Ms. / Mrs. ______________________________________________
towards rent of the Premises as mentioned in the below address.
Name & Address of the House Owner (Affix Revenue Stamp of Rs.1/-)
Name: ______________________
Address:_____________________
______________________________
______________________________ Signature of the House Owner