Panchayat:Repo18/vol1-page1069
- b) any dated evidence issued by the Commissioner of Land Revenue or Collector or Revenue Divisional Officer or Tahasildar or Village Officer with respect to the unauthorised reclamation and/or any similar documentary evidence to this effect.
- i................
- ii................
- iii...............
- iv..............
- c) photographs of the land unauthorisedly filled up, signed by the owner, to the effect that "this is the paddy land which has been filled up unauthorisedly/due to natural reclamation before the 12th day of August 2008"
- i................
- ii................
- iii...............
- iv..............
- d) Orders obtained earlier, if any, granting permission to utilise the land for any other purpose issued under any law in force before 12th day of August 2008.
<divclass="floatright">Signature of Applicant ........................................
Name of the Applicant ........................................ (In Block letters)
Full address:
Place:
Date:
............. hereby declare that the unauthorised reclamation was carried out before the 12th day of August 2008. I also declare that all the information furnished by me are true to the best of my knowledge and belief. I also agree unconditionally that the Collector/Government can take any action as may deem fit if any of the information furnished by me does not confirm to facts.
Place:
Date:
...................................Village
...................................Taluk
.....................................Corporation/Municipality/Grama Panchayat
1. Particulars of application
- 1. Application received on
- 2. Name and address of applicant
- 3. Verified on
- 4. Returned to applicant for completion
- 5. Completed application received on
- 6. Status of land in Draft/Data Bank
- 7. Sent to Village Officer on
Date of receipt of Form 5 by the Village Officer...............................................
2. Particulars of land:
- 1.Sy. Number
- 2.Re Sy. Number (if any)
- 3.Extent of paddy land reclaimed
- 4.Thandapper No:
- 5.Thandapper holder
- 6.Nature of land in BTR:
3. Particulars of Current usage of the reclaimed paddy land: (based on site inspection)
- 1. Current use of land : Lying fallow/Residential/ Commercial/Commercial-cum-residential/Others (attach site mahassar also)
- 2. Whether the photograph submitted by the applicant is genuine : Yes/No