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D4441319440/2012

Zone Name

02

Division

022

R.DURAISAMY RAMASAMY . PERUM PALLI VILLAGE,PUNGAMPATTU NADU PUDURNADU VIA,JAVATHU HILLS TIRUPATTUR T.K.VELLORE DIST 0 NO:18 B BLOCK POLICE QUARTERS OLD JAIL ROAD MINT CHENNAI 600001 Male 67 YEARS 16-DEC-2011 NO:18 B BLOCK POLICE QUARTERS OLD JAIL ROAD MINT CHENNAI 600001 COC/2011/02/022/000245 27-DEC-2011 22-MAR-2012 -

Name of Father / Husband Name of Mother Permanent Residential Address

Address of the deceased at the time of death Sex Age Date of Death Place of Death Registration Number Date of Registration Date of Issue Remarks (If Any)

22-MAR-2012

Note : This certificate is computer generated and does not require any Seal/Signature in original. The authenticity of this certificate can be verified at www.chennaicorporation.gov.in. The Registration Number is unique to each death.