FORM-D
(See Rule 12(11)
Appeal Under Section 9 of Kerala Land Tax Act 1961
(Act 13 of 1961)

To

The District Collector  day of  19   

                  The petitioner                                                        of                       

              shows as follows:       

(1)Under sections 6(2) 6(A) 3)/7(3) of the Kerala Land Tax Act 1961, the lands mentioned below held by me have been assessed with Basic Tax at the rate of Rs.                  Ps                     per hectare per year.

  (2) Original/Certified copy of the order appealed against is attached herewith,

  (3) Date of service of the order on the petitioner

  (4) Matters appealed against are:

         (a)

         (b)

         (c)

(5). Statement of facts

(6) Grounds of appeal

(7) The petitioner has paid the Tax amounting to Rs.          Ps.       as per tax receipt   dated             from the Village Officer/Village Assistant as required in Rule 12(iii)

(8)The petitioner, therefore prays that            

DECLARATION

I,                                                       the petitioner, do hereby declare that the details furnished above are true and correct to the best of my knowledge and belief.

place

date                                                                               Signature of the applicant