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                                                                            GOVERNMENT             OF MAHARASHTRA                                                                       FORM-6
                                                                                          3lRW:r f<fSf11T
                                                                                 DEPARTMENT            OF HEALTH

                                                                 MUNICIPAL CORPORATION NASHIK SATPUR ZONE



                                                                                         ~~-~
                                                                                   DEATH CERTIFICATE



~      q ~     ~            3If~,     1969 '£<IT ~    12/17   3ITfUr J1'mT? ~       3ITfUr ~       ~      f;r1:rn,    2000       it f;r1:rn       8/13    ~     ~       .3iGl3frit.
(ISSUED UNDER SECTION 12/17 OF THE REGISTRATION                  OF BIRTHS & DEATHS ACT, 1969 AND RULE 8/13 OF THE MAHARASHTRA REGISTRATION OF BIRTHS & DEATHS
RULES 2000.)


~       ~       <t; 31Tt *t, ~  ~    ~       ~ ~         <l1~q~101 , ~    <rrfucf; , ~  <rrf~ , m '£<IT ~      ~      31ft.
THIS IS TO CERTIFY THAT THE FOLLOWING INFORMATION HAS BEEN TAKEN FROM THE ORlGINAL RECORD OF DEATH WHICH IS THE REGISTER FOR MUNICIPAL
CORPORATION NASHIK SATPUR ZONE OF TAHSIl/BLOCK NASHIK OF DISTRlCT NASHIK OF STATEJUNION TERRlTORY MAHARASHTRA, INDIA.

~       <fICf / NAME OF DECEASED         : ~tlT<M ~     ~        1 SUDHAKAR GARBAD MAHAJAN                ffin / SEX: ~               / MALE

3ITtlT{ ~  1 AADHAAR NO.:
XXXXXXXX5528

1lJli ~    / DATE OF DEATH:                                                                               ft fuq;rur / PLACE OF DEATH:
22-05-2021                                                                                                   SUSHILA MULTISPECIALrrY HOSPITAL/SUSHILA MULTISPECIALITY HOSPITAL
TWENTY-SECOND-MAY-TWO THOUSAND TWENTY ONE
                                                                                                             -q;:ft / -q;;fr ~            -;:rrq I NAME OF HUSBAND / WIFE:
                                                                                                          ~               '1mq;( ~               1 SARASWATI SUDHAKAR MAHAJAN
 '[if ~        <nT / AGE OF DECEASED:
66 YEARS                                                                                                     3ITm< ~                 I HUSBAND/WIFE             AADHAAR NO, ;



3ITW 'fOl -;:rrq /      NAME OF MOTHER:                                                                      ~             trfi <fICf / NAME OF FATHER:
~~               ~         / SAYABAI GARBAD MAHAJAN                                                       ~           ~      ~                I   GARBAD DHUDKU MAHAJAN

 3ITtrrl ~         /    MOTHER'S AADHAAR NO. :
                                                                                                             3ITm< ~               I FATHER'S AADHAAR NO. :


-.:r«<r ~    1r'{.g>i~?I'l1 'Q'ilT / ADDRESS OF THE DECEASED AT THE TIME OF DEATH:                        -.:r«<r ~              ~                ~       / PERMANENT ADDRESS OF DECEASED:
 GAT N 488 , SAl BANGALA , PAPAYA NARSARY JAVAL ,
TRAMBAK ROAD SATPUR , NASHIK, NASHIK, NASHIK, MAHARASHTRA                                                 GAT N 488, SAl BANGALA, PAPAYA NARSARY JAVAL, TRAMBAK ROAD SATPUR,
m;rrl?LL,m~,~~~,                                                                                          NASHIK, NASHIK, NASHIK, MAHARASHTRA
~ irs ~          , ~1<f;    (6l q:;Tq.), rrrf~, rrrf~,
~-                                                                                                       m; rr ~n:, mt;;'1r;:rr , 1:fQ'm ~                          ~    , ~          'Us m;:rq{ , ;m1rq;- (6l
                                                                                                         q:;Tq.), <rrf~, <rrfucf;, ~                                                           ...

~      ~       / REGISTRATION         NO:                                                                ~       ~                / DATE OF REGISTRATION:
0-2021: 27-90331-000627                                                                                  08-06-2021

mr / REMARKS (IF ANY):

                                                                                                                                                          ;..

~         ~             ~       / DATE OF ISSUE,                                                         ~             ~             'I!TT~           /   ISSUING AUTHORlTY
09-08-2021
                                                                                                                     3ll'-~    ~    if 1pj)
                                                                                                                 SUB-REGISTRAR (BIRTH & DEATH)
                                                                                                          MUNICIPAL CORPORATION NASJUK SATPUR ZONE



UPDATED ON :
2021-06-0813:25:33




                             ''THIS IS A COMPUTER GENERATED CERTIFICATE \\iHICH CONTAINS FACSIMILE SIGNATURE OF THE ISSUING AUTHORITY"
                                               THE covr. OF INDIA VIDE CIRCUlAR NO. 1/12/2014-VS(CRS) DATED 27:1ULY-2015 HAS
                                            APPROVED THIS CERTIFICATE AS A VAllO LEGAL DOUCMENT FOR ALL OFFICIAL PURPOSES .

                               • ~~          ~~~                  oi'IC?'Il'tn ~'ltiU.         I   ENSUlE.REGISTRATIONOJ.'EVER1·BlRTIUNDDE.\m·