A FIX COURT FEE STAMP OF RS.2/- 

To
The Mandal Revenue Officer
.........................................Mandal
Hyderabad, A.P.

Sub: Application for Issue of Legal Heirs Certificate/ 
Family Members Certificate -  Requested - Regarding.

Respected Sir,
          I beg to submit that  my.................................................................................................
R/o.H.No.....................................................................................................................................................................................
expired on...............................................................He/She  as a pentioner.....................................................................
He, She was expired while in service working as a ...................................................................................................
in the office of the....................................................................................................................................................................
I have applied for legal Heirship certificate to submit the same at......................................................for getting to claim the
benefit for claiming Department  inner benefits. life time arrears appointment of my .......................................................
Smt./Sri./Kum.....................................................  to you for verification, I  may kindly be issued a Residential Certificate. 
On receipt of the Certificate from Mandal Oficer,  I will submit the same......................................................................
for the purpose of.....................................................................................................................
Name of the Family members are given below:
Sl.No. Name of the family members Age
Years
Relationship with
the deceased
Remarks/Status
1.
2.
3.
4.
5.
6.
7.
I therefore humbly request your good self to issue the in Legal Heir ship Certificate/Family member Certificate 
and submitted death certificate No...............................dated...........................................and pension payment  slip/service
certificate of his/her deceased of submitted herewith for kind per ................ and necessary action.
Dated:

Yours Faithfully

Name:

(                                                        )

Address: