Domicile Certificate Application

Your name*

Your address*

Authority / Tehsildar office*

Years resided in the state*

Purpose of the certificate*

Date of application*

State*

Format:

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To, [authority_name] Subject: Application for issue of Domicile Certificate I, [applicant_name], residing at [applicant_address], have been a resident of this state for [years_of_residence] years. I request that a Domicile Certificate be issued in my name. PURPOSE This certificate is required for: [purpose] I enclose the supporting documents evidencing my residency as required. I request that the certificate be issued at the earliest. [applicant_name] Date: [application_date]

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Domicile Certificate Application

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