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DECEASED NAME
FATHER / HUSBAND NAME
DATE OF DEATH
DATE OF CREMATION
PLACE OF DEATH
CAUSE OF DEATH
DOCROR/M.O. NAME
REGISTRATION No.
P.M. No.
DATE OF P.M.
U/D Case No.
DATE OF U/D CASE
PS NAME
AGE in YEARS
ADDRESS
SEX
PLACE OF CREMMATION
RECEIPT NO.
CREMATION RECEIPT NO.
FEE PAID Rs.
MONEY RECEIPT No.
MONEY RECEIPT DATE
CONTACT NO.
APPLICANT NAME
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