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Received from Rs.11500/- (Rupees eleven thousand and five hundred only) towards house rent per month from the month April 2009 - March 2010. In the respect of house at H.No:XX, X D Main, 1st stage, , -
Name and address of the landlord: X. XXXXX XXXX Address of the house: Addr Line1 Addr Line2 City PIN - 560001
Signature of the landlord : ___________________________________