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NO NAME OF THE APPLICANT ADDRESS CONTACT NO REMARKS Ms Kasi Associates DNo439169TSN ColonyVisakhapatnam 9247237374 Builder Ms Sivani Developers Promoters Shop No2 1st FloorNH5Opp Kunchamamba Temple. If pets were not spayedneutered please explain why If you do not still own these pets please explain what happened to them For the dog you are applying to adopt have you owned this breed of dog before What do you know about this breed and do you hav 51 KASTURBA ROAD KASTURBA ROAD BANGALOR KARNATAKA 560001 75 Old Airport Road Bangalore AIRPORT RDBANGALORE GOLDEN TOWER AIRPORT ROAD KODIHALI BANGALOR KARNATAKA 560017 367 Seshadripuram Bangalore MEERA SADANNO 60 1ST MAIN ROAD SESHADRIPURAM BANGALOR Printed Name of Enrollment Officer Signature of Enrollment Officer brPage 2br APPLICANT Completed by applicant Name Date of Birth Last First MI Los Rio s ID if known Age Grade Level Phone Current School Attending M Standard Time at the address of the Applicant ANSWER ALL QUESTIONS IF THEY DO NOT APPLY INDICATE NOT APPLICABLE Applica nt is a ndividual Corporation Partnership Joint Venture Li mited Liability Company Other Specify b wne Tenant c arber Shop Beaut 4 Applicant Email Information for Birth Certificate Search 5 Child Name 6 Date Of Birth 7 Fathers Name 8 Mothers Name 9 Citizen Service Centre BRUHAT BANGALORE MAHANAGARA PALIKE BIRTH CERTIFICATE REQUEST APPLICATION FORM 1 Name of Company ACN Registered Address City/Suburb State Postcode Telephone Fax Directors 2 Applicant Details (if the Applicant is a Trust) Name of Trust Date of Trust Names of beneficiaries / unit SlNo. Id DistrictIndustrialPark Nameofthe Applicant CategoryLineofActivityStatusRemarks Considered PlotNo. Considered Areain (Sq.m) 1861VisakhapatnamIT-NONSEZ-HILL2 INDOVA Software(P)Ltd TechnocratOth NY Community Type Community Name Address 1 Address 2 City State Zip Contact Information First Name Last Name Title Address 1 Address 2 State Zip Phone Email LOCAL COASTAL EROSION HAZARD AREA SIGNATURE AND TITLE OF AUTHORIZED AGENT MINNESOTA DEPARTMENT OF PUBLIC SAFETY DRIVER AND VEHICLE SERVICES445 Minnesota Street Saint Paul, MN 55101-5187 Phone: (651) 297-2126 TTY: (651) 282-6555 We 444444Residential Address in Canada where the applicant ordinarily residesCan be left blank if submitting the Assisted Living formShipping Address where the product will be shippedMailing Address w Underscored stricken and vetoed text may not be searchableIf you do not see text of the Act SCROLL DOWN765CHAPTER 583The people of the state of Wisconsin -represented in senate and assemblySECTION 1 2 ITD 3522 Rev 09-21Supply This certification is used to support a claim that you are an Idaho resident You must be a resident of Idaho to be eligible for a driver146s license or identification card I Full Legal NameBy signing below the Applicant verifies that the Applicant is the person whose name appears above and that the address provided is theApplicants current mailing addressprinted or typedD