Form No. 61

Form of Declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income tax in respect of transactions pecified in clauses (a) to (h) of rule 114B

1.    Full name and address of the declarant: ___________________________________________ _____________ ____________ ____________________________________________________________________________________________________________________________________________________
2.    Particulars of transaction:
3.    Details of the document being produced in support of address in Column(1) __________________________________

I hereby declare that my source of income is from agriculture and I am not required to pay income tax on any other income if any
Date: __________
Place: __________

Signature of the Declarant

Verification
I, __________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.

Verified today, the _______________ day of ___________Year ________

Date: ___________
Place: __________

Signature of the Declarant

Instructions: Documents which can be produced in support of the address are:-
i.    Ration Card
ii.    Passport
iii.    Driving license
iv.    Identity Card issued by any institution
v.    Copy of the electricity bill or telephone bill showing residential address
vi.    Any document or communication issued by any authority or Central
vii.    Government, State Government or local bodies showing residential address
viii.    Any other documentary evidence in support of his address given on the declaration.