ANNEXURE - IV
PROFORMA FOR FURNISHING DETAILS OF PROPERTIES UNDER SECTION 22-A(1)( e )
Sl.No. Name of the District Name of the Mandal Name of the Village/Town Sy.No. & Sub.division No.(If any) Town Sy.No.(If applicable) House No.(If applicable) Extent Name of the owner/Occupant/Interested person Reasons for prohibition
1 2 3 4 5 6 7 8 9 10
1 West Godavari Koyyalagudem Koyyalagudem NIL NIL NIL NIL NIL NIL
TAHSILDAR
Koyyalagudem