BEFORE THE TAHSILDAR SURYAPET MANDAL, SURYAPET

SURYAPET DIST.
AFFIDAVIT
I, DHARAVATH LAXMI W/O DHARAVATH BHEEMUDU (LATE) aged about
66 years, Occupation: Retired Bank Manager, APGVB, H.No 1-6-102/3/3 Sri Vidya Nagar,
Suryapet Vill, Suryapet Mandal, Suryapet Dist. Telangana do hereby take an oath and submit
as follows:-
1. That I am legally the wife of Late. DHARAVATH BHEEMUDU S/o DHARAVATH
LATCHYA, R/o.H.No 1-6-102/3/3, Sri Vidya Nagar,Suryapet Vill, Suryapet mandal
Suryapet,Dist Telangana. and deponent herein and hence, I know the following facts of this
affidavit.
2. That my Husband was died on 11-06-2019 at our home in Suryapet, while his death
was General Death leaving behind me the following Family members.
Sl.No. Name Relationship Age
1 DHARAVATH LAXMI WIFE 61
2 DHEERAVATH VANAJA DAUGHTER 41
3 DHARAVATH SHAILAJA DAUGHTER 40
4 DHARAVATH RAVI SON 36
That I am in need of ‘FAMILY MEMBERSHIP CERTIFICATE ‘of my husband
Late DHARAVATH BHEEMUDU and request the Hon’ble Tahsildar SURYAPET, to kindly
favour me with “Family Member Certificate”’ as prayed above in the interest of justice.

That the above facts are true and correct to the best of my knowledge and belief.

DEPONENT

PURPOSE : All Pvt & Govt Benfits

(DHARAVATH LAXMI)
th
Sworn and signed before me on this the 10 Day of JUL 2019 at Suryapet.

NOTARY
 BEFORE THE TAHSILDAR MOTHEY MANDAL, NALGONDA DIST.
AFFIDAVIT
I OOGGU LAXMAIAH , S/o. Late. LINGAIAH, Aged : 22 years, Occu : Un-Employee, R/o. Raghavapuram
village of Mothey Mandal, Nalgonda Dist. do hereby solemnly affirm and state on oath as follows :
3. That I am the legally Son of Late. LINGAIAH S/o. Late. PICHAIAH and Late. VENKATAMMA W/o
LINGAIAH R/o. Raghavapuram village of Mothey Mandal Nalgonda Dist. and deponent herein
and hence, I know the following facts of this affidavit.
4. That my Father died on 24-01-2010 and Mother died on 01-04-2009 at home while
they were Natural death leaving behind me the following Family member.
Sl.No. Name Relationship Age
1 Ooggu Laxmaiah Son 22

3. That I am in need of ‘FAMILY MEMBERSHIP CERTIFICATE ‘ of my late father and my late

Mother of and request the Hon’ble Tahsildar Mothey , to kindly favour me with ‘Family Member
Certificate ’ as prayed above in the interest of justice.
That the above facts are true and correct to the best of my knowledge and belief.

DEPONENT

(OOGGU LAXMAIAH )
Sworn and signed before me on this the ……….. day of March, 2010 at Suryapet.

// Seal // NOTARY