REPORT OF REVENUE INSPECTOR .....................CIRCLE
To						Date: ............................
The Mandal Revenue Officer,
.................................. Mandal,
Sir
Sub: ISSUE OF L.H.C/F.M.C. A/c..................
 S/o. ............................................ R/o. ................................Ref:  Endt. of the MRO/P.T/SUPDT, Dated ...........................A/c ........................... In continuance to the endorsement cited I had been to be  locality  during the enquiry.
It reveals that applicant's Husband/Wife/Mother/Father, Sri/Smt. ..........................S/o. W/o. ..................................R/o. H.No. ...................... in the office of the ...................... has expired on ....................................  at ..........................................................   leaving   behind  the following Legal Heirs/Family Members of the deceased. He is issueless/bachelor.
Sl.	Name of the	Age		Relationship with          Marital
No.	family member			the Deceased.	          Status.
1. ........................................................................................................................
2. ........................................................................................................................
..
..
12. ......................................................................................................................
Except the above there are no other Legal Heirs/Family Members of the deceased and he has married only one wife/two wives in his life time. Legal Heirs/Family Members Certificate is required for the purpose of pension and other benefits, the original papers are returned herewith also with sworn statement of a Govt. Servant who knows well about Legal Heir/Family Members particulars of the deceased.	
						Yours faifhfully,
				REVENUE INSPECTOR --------CIRCLE