BEFORE THE ASSISTANT COMMISSIONER

________________ SUBDIVISION, ________ LRF APPLICATION_____________/2012 APPLICATION SEEKING PERMISSION UNDER SECTION 80 OF THE LAND REFORMS ACT, 1961. KARNATAKA

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Name of the Applicant with detailed address (in Block letters) Occupation Show how you are doing agricultural activity from 01-031974 Whether you annexed the G-Tree of your family What is the average annual income of your family for the last five years Which land is proposed to be purchased (a) Agreement copy entered between the land owner and the applicant. (b) enclose certified copies of RRs and Mutations issued by the Revenue Authorities. (c) When and how the land/s has / have been obtained by the Seller(s). Furnish List with title certificate . In such cases where seller has himself purchased the land he now proposes to sell. (i) Whether the seller has obtained Permission from competent authority before purchasing that land. (ii) If he is a Income Tax payee whether the

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Income Tax clearance certificate issued from the Income Tax Department is enclosed. (iii) Whether any case under 79-A and B has been registered in respect of land now proposed to be sold. If yes, details thereof. (i) Whether the applicant is already having agricultural land in his name or in the name of any other family member. If so, furnish the details. Village, Taluk, Sy. No. extend category-A, B, C, D under Karnataka Land Reforms Act, In case of non-Agricultural land, the area in square meters and bifurcate utilised and nonutilised area. (ii) Extent of land for which permission is sought and justification thereof. If income Tax payee copy of the Income Tax certificate issued from the Income Tax Department enclosed. Whether the proposed land falls under Zoning regulations of the country and Town Planning Act/ 1961 (Certificate of the Concerned Planning Authority to be enclosed). Source of finance for the proposed purchase. Show how the land has not attracted any bar

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under any provisions of law in sale of such land. Professional expertise of the applicant in the respective field.

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VERIFICATION I ______________________________ the applicant herein above do hereby solemnly affirm and verify the contents of this application as true and correct to the best of information and belief. Nothing herein is hidden, nothing is untrue, all facts are true and correct to the best of my knowledge. Date Place (Applicant)

List of documents annexed 1. RTC & MR of land for which permission is sought. 2. Title deed of land 3. Sale Agreement copy 4. RTC of the applicant family from 01-03-1974 5. Saral copies of IT for past five years 6. G-Tree of applicant 7. Affidavit swearing that applicant does not come under 79A &79B 8. Title certificate of the land 9. Source of finance list 10. Certificate from planning authority 11. List of lands held by applicant 12. Others