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Value Rs. 25/- only

KHARDAH MUNICIPALITYKHARDAH, NORTH 24-PARGANAS

Application for MutationIApportionment of Taxes(Please use capital letters to fill up the Application)

Date of Application : .

Name of the Applicant : .

Name of Father/Mother/Husband : .

Holding No. : Ward No. : Water Connection No. : .

Street Name : .

Pin Code: Phone No. :

Owner Details (In case of Single Owner) Sex: Male/Female/Others

Name of the Transferer : .

Name of Father/Mother/Husband : .

Street Name : .

Pin Code: Phone No. :

Owner Details (In case of Multiple Owners) :

AddressSl.No. Name of owners Name of Father/Mother /Husband Sex

Service Type : DNormal DTatkal

Mutation Type: D General Mutation DNatural Successor DDocument Type: D Will Deed D Sale Deed D Gift Deed

Measurement Details :

Floor No. Age Occupation Usage Construction Nature Covered Area (Sq. ft.)

Monthly Rental (In Rs.)Cost of Land (In Rs.)Cost of Construction (In Rs.)

~~--------------------~---------------------r------------------~

Details of the Holdings :

1. Right on the Land - 5. Nature of the Holding - Residential/Commerical/Others -

2. Mouza - 6. Area in Sq. mtr. -

3. Plot No. - 7. Ward No.-

4. Khatian No. - 8. Road -

Name of the Transferee : .

Name of Father/Mother/Husband : .

Street Name : .

Pin Code: Phone No. :

In-Charge of Assessment Department's Report (If the said property is registered them) : .

1. Book No. : 2. Volume No. : 3. Page No. : To .

4. Deed No. : 5. For the Year: 6. Date of Registration .

Declaration:

I/We hereby declare that the information provided in the application is true to the best of my / our knowledge. If anyirregularities/false information is found I/We shall be responsible for it. I/We take note of the contents includingguidelines. I/We hereby undertake to prompt report to the Municipality, in case of any changes in the use of thebuilding. I/We will abide by the rules and regulations of the Municipality.

[Note: If any deviation or alteration in utility of the Building is made in future, if should be informed to theMunicipality for regularization within three months.]

In the event of non compliance of the above, I/We will be bound to abide by the decision of Board of Councillorsto be taken against me/us.

Address:

Date: Signature of the Applicant

Assessment Department to be attached (Please put a tick)Nature of Holding - Residential/Commercial/Flat1. Xerox copy of latest Tax Receipt, 2. Xerox copy of T & c.P. approval, 3. Road Dimension, 4. Any objection fromother holders (may be provided in separate sheet), 5. Any legal problem, 6. Any other comments.

Executive Officer's views Signature of Assessment-in-Charge

Final Approval: