- .'..-.:~,;. -

"

~o~· ~Qf 3rr~~ ANDHRA PRADESHSl. No.JJ:.t ... Rs.L~k. ..DateKL~.~/t..s--So! I to ...•&~..~.~~ ....~~"i •• ~ fh .N'~~~

I, ~ ~ / ~~A-.~r horn•.• · •...•••..•.••...............•..........••••.• ,1 /.., ,.~ 7r~~./

iAffidavit to be filed by the candidate along with nomination paper before the returning officerfor election to Legislative Council (Name of the house)

gFrom NALGONDA-WARANGAL-KHAMMAM Constituency (Name of the constituency)

PART-A

I, GOVERDHAN KUMAR KORE son of NAGA BHUSHANAM Age 34 yearsresident of H.No. 1-20, Kesharajupally, , Nalgonda Pin 508001 (Mention full

mpostal address) , a candidate at the above election, do hereby solemnly affirm and stateon oath as under:

(1) I am contesting as an independent candidate

=:...:=.:....:.....;1.....:....:=..:..!....:...::=:..:.....=.~-''--=ST~A~T=E(Name of the

id (if any)

',<,~MOHD. Mm~ffJ~AArDfr;R

.•V B •.••••tL.B.. t\ VOC

Oft.: Opp \~ftt8rfn3ry Hospital. MlG. RoadManyam ~ha'ka. NAlGONDA.S08 oot

~DDOlRted by Govt. of INDIA

.'i'- > -

-'::..' ;

.~. "

. ,, ,

/ .

(4) Details of permanent Account Number (PAN) and status of filing of Income Taxreturn:

Sl. Names PAN The financial year for Total incomeNo which the last Income -tax shown in Income -

return has been filed tax return (in

- Rupees)1. Self I- NO- - N3 - ~ fJ a -2. Spouse. I-- ;J (J ~ .- rJ 0 - - NO -3. Dependent -1 - NO - - NO - - NO -4. Dependent-2 - tV 0 - ,- f'.l G - - rV D -5. Dependent-3 - rJD - - N~ - - rJ() -

(5) I am not accused of any offence(s) punishable with imprisonment for two yearsor more in a pending case(s) in which a charge(s) has/have been framed by thecourt(s) of competent jurisdiction

~ r. •• If the deponent is accused of any such offence(s) he shall furnish the following.~>".t\UAOE.n"'formation:

.: rr: ~<> • '¥I" q,.3// ".. (.

r'"y 'l~~"i..~(NOTAR" r..,~ _:,!.I •.•o,rH~d ov =!:

~

~' .,~ " 'J" '(j <:'~. ~;

~\ . /~.~\~ ~~~ ,~,~--~\.~~.'.~..•.~U(A. ~ ~ ,

"~.:'..~.' ~ .•

1.1k.~

JI~-TESTED"NOt .y

'4

MOHO.. A DEERa.Com.• t .~)

AVVOCATOffi' OOP Vp.tp.rin~ryHospital. MlG. RoadManyalTt Chalka, NALGONDA-508 001

~ointed bv Govt. "Of lMetA

(i) The following case (s) is/are pending against me in which charges have been framed by the courtfor an offence punishable with imprisonment for two years or more:-

(a) Case/First Information.... " ....... '.

ReportNo.lNos. together with complete

~N.- -details of concerned Police ~

Station/District/State., .

:(6) Section(s) of the concerned Act(s)... ...., ...

'and short description of the offence(s) -t--l·A.-forwh!s~h charged .- .... , ....

, (c) Name of the Court, Case No. and' date..N4, ..=of order taking cognizance: - .... .¥ ••••

J~)'Court(s) which ihimed the chargefs)...... ":,""M.," _M ••• " • ..='cN~"··~ .... ....- .... w ••__•.

'•. _.,····.··,·;· .. ::····:::·"·' ... '1':1'... :.:.::1:·::.',,.:,:: ,,:' .... '.: .. _..... ~.,."' ..... -- ..••.•••.•... , ..

"'(e) 'bate(s) on which the charge(s) - N A; ~was/were framed-~.... , .-. .... ..

.... .- . .-.-(t) .Whether all or any of the

,proceedings(s) have been stayed by -N~-_,'M

,€l:l)y~ourt(s) of co~p~t~!lt jurisdiction"

(ii) The following case(s) is/are pending against me in which cognizance has been taken by the court[other than the cases mentioned in item (i) above]r-

....- ',,-,:::.' . . ..

(a) Name of the Court, Case No~and"dateof order taking c9gpi~Cln9.t(,: .

i (b) 'The details'ofca"seswh'e~e the courthas taken cognizance, sectionfs) uf theAct(s) and description of the offence(s)for which cognizance taken

.., .(c) Details of Appeal(s)/AppJication(s)

for revision (if any) filed against theabove order(s)

(6) I have been/have not been convicted of an offence(s) [other than any offence(s) referred to in sub-section (1) or sub-section (2), or covered in sub-section (3), of section 8 of the Representation ofthe People Act, 1951 (43 of 1951)] and sentenced to imprisonment for one year or more.

Ifthe deponent is convicted and punished as aforesaid, he shall furnish the following information:

In the following cases, l have been convicted and sentenced to imprisonment by a court of law:

;~~;;-.de~~~~:,~;;se;.1:,r:\on(S).:d

~r::,~~,~d§Yi~~i..~ir~;e~~£(:).:::c:~.",;' \ a ,: 0 ..:..' 'a d' t¢s oforders): NA:-. ,~ (c) p'~' ·;-,-·~-:;-I11~e":;-:.nt~i:",.I!.l""p;F.,-?=se"-d-,,,,,.-+...,,-,--.:...--'-_+-_--'-'-.:;:...;...._~_~_-~"'_~__ -_'-'--~"""'___.............j"~'~L {ther any"appeal w~s/has been

-;~~_ ..••.?:. filed against the convictionorder" If so, details and the ~/~erfstatus of the appeal: ".

K,~JPIJ' J L<,~ 0""'" 11LI •..•E R

.tL.BAVVOC

Offi: Opp Veterinary Hospital" MlG, Road"anyam ~halka, NAlGONDA-508 (0)

'f.9oomted bv Govt. of INDIJ '

(7) That I give herein below the details of the assets (movable and immovable etc.) of myself, myspouse and all dependents:

A. Details of movable assets:

Note: I.Assets in joint name indicating the extent of joint ownership will also have to be given.Note: 2. In case of deposit/Investment, the details including Serial Number, Amount, date of

deposit, the scheme, Name of the Bank/Institution and Branch are to be givenNote: 3. Value of Bonds/Share Debentures as per current market value in Stock exchange in respect

oflisted companies and as per books in case of non-listed companies should be given.Note: 4. Dependent here has the same meaning as assigned in Explanation (v) under section 75 A of

the Representation of the People Act, 1951.Note: 5. Details including amount is to be given separately in respect of each investment

Self Spousej

Dependent-1 Dependent-Z Dependent-3

(iii) Details of investment in Bonds,debentures/shares and units In \L- "-companies/Mutual funds and others N. · ~ancl the amount

(iv)j Details of 'investment in NSS,:1 Postal Saving, insurance policiesr and investment in any Financial ~ L- ~ \.L-i instruments' in Post offlce=-crl-I .. ."1,'.'

Insurance Company and the amoun](v)" Perso~af J'oans!aavlihcegTVeit to

any person or entity includingI firm, company, Trust etc., and other ~'-/receivables from debtors and the

, amount

, S1.'No.!

" ' .. ' ,- -,

Description

(i) i Cash in hand K'.rrI'I/- ~ -!~=44":::':::;::'::"::':":"::'::::'::::-'-------J-:.l,~~-b-----I-..,.-----",.-,--::--+-_ ,'-(ii) Details of deposit in Bank '5"CO ,~ ,

accounts(FDRs, Term Deposits and 5'OO/...- ~.B.'\+• ; all other types of deposits including A..~,£\ ~I\ec.~

'saving accounts), Deposits with ~~~ fI q-e ~'!'IIFinancial Institutions, Non-Banking ~~f-, ~~

Financial Companies andCooperative societies and theamount in each such, deposit

~~ ~f\ ~f\---

''''''''-'' '"''''''''''''' ..

~k i

~~ ~.~, -

~~ ~~ ~t\ ,

(vi)' Motor Vehicles/ Aircrafts/Yachts/Ships (Details of Make, registration ~\./' l\\J.-number etc. year of purchase and ~amount)

(vii) JeweIJery, bullion and valuablething(s) (give details of weight and ~v

~~~~ value):Y~~- Il~[.2\, other assets such as value ~v~I lo~r\ins/interest I I a __ ~

~I Pt4014iR~~r¥f- Total Value 1/ =.~:~.,'tCYoO~·'U",om'';'~rl It , .VUIt"dRV

"'" 'C\i ()\ ~':: •

~\\-'; .. o"'(J"~:!r~j MOHO. ~..I~, ~.f,' "..~~J A'vr~U~ER

~~LiA.Mt~~~-""-,,~~-,,, Offj. ApVOC .B

opp \leterrn~ry H.ospnal YLG RManyam ~ha'ka, NALGONDA-508 00:

~DDOlQtedbv Govt. of INDIA

B. Details ofImmovable Assets:

Note: 1. Properties injoint ownership indicating the extent of joint ownership will also have to beindicated

Note: 2. Each land or building or apartment should be mentioned separately in this format

S. Description Self Spouse Dependent -J Dependent-2 Dependent-S.No. ..

(i) Agricultural Land;'A N A NALocation(s)' NA N NI\

Survey number($) .... ".;'_,v , ..

Area (total measurement in acres) ~A:: N '" 1'\fr ....!L~,t\ " N.AWhether inheritecfproperty"

~..." ..., ,.~-. ... _ .._._ . ., ..

•f\'''- NA. f'\~ N~ 1'4A-(Xe,s-Qtl'i21-

0'- - "';';';""";;';':~:;H'_'_" . _._H· .. - .._ .. .- ... - .... ,.. , ........, ...jj', ......•..... •_.c. .... ' •.•. . ...

Datcot purchase In case of self-~ ~A N~ MA Nf\

acquired property., .--- .. .' '" .-~..

Cost of Land (in case of purchase) ~~ t-\ A NA NA N~. at,the time ofpurchase . NAAny investment on the land by way t\t\ ~~ 'NA .~:t\.of development, construction etc.

Approximate curr~nt.maT!<'~tY'l.lue.... 1'>\~ ~ ••..~ ... .. .......~~. ~rA .~f\ ....(ii) Non-Agricultural Landt:

:NALocation(s) Nf\ NP\ : ,~~ N~Survey number(s)

.. :";._A'<" .'~+\:Area, (totalil1~as~~~ent:in sq.ft~t ........1'\1\ ; t-\'~, ~f'- Nt\...,~ ..

Whether inherited property ~k MA t--.\ f\. -r.~,h. '-Nit-(Yes or No) --.._ ... -.-.-.~-•.. - . -. - -...... . ,- .....

ofself-., - ., ..

Date of purchase In case \"\\ ~ ~A ~A Nt\ [~-t\: acquiredproperty .... ... ... ....... .. ".' ... "". ........ ;,,, .....

Cost of Land (in case of purchase)1

,N l\ NP\. ~~ , 1'\1\ ~1\aJ the time of purchase . ... ..

/' Any investment on the land by way,~~ ""~ N.A.-. i\\t\ N~C" of development, constructionetc. ....... ,

,.. ..~. ~..

Approxjmat~~ll~rel1t market value. ~~ ,,\ A N?\- l_ ..NI\ ~A-

(iii) ~Commercial Buildings:. (including apartments) :t\~ ~1\ ~~

,.'Nf\~?\

-Location(s)-Survey number(s) .. .. - .

A;ea'(t;tnf m~'asur~lllent' ill sq:i't.).· - 'A::- .. ~~..,~~ Nt\ 'M-t\- Nf\N

B:ullt~upArea·(total·m'easul;ement,v·v.

N.~ ~~ N ~ Nt\ t--\~in sq.ft.), .Whether inherited property ...

.... .

"~J\...

t'-\A 1'-1 ~ N1\ \'\\f\

,~

.....,. . .", .(Yes orNo)iUAO . .. ...... ~,"'e,

W , ......-.~~~ of purchase in case of self-' ~A: NA N ~ Nt\ 1'\£\(:r ac:C"J roperty "

+ -. ..

TA: ~~st '(Js:. property (in case of tl,t\ t'lA NA 1'-\ ~ "'\1\"', W ••' .,'Itc·purchasskat the time of purchase~.; ,. 0" ~n'y Jn~slment or!me B~ -~

NA f'.'A. NA N/\\. way ~·fevelopmenNeT'."¥/l t-.\ A '.~+....... etc;,.J,)~~_._ ....~C••___ • _, ••~, ____ , _._~ ·~N~~ ~N'-fZ""""'" N'~··f~Uct-. "; )dr~at~ current mark~ value N~ ;Nt\...'.•.•.~!"!-- rn.iru). ~Ij}~t~,-, ,QLIAIJr.r.f\_4_

.~IlIA I4iA"rJ'Y·lL.B\c

. A , 1Cl\lJT t- A£..il. ~Oftl nor \/p.tf!'If\~~ l1ospital, M[G. tFfoad~anyan. Cholka. "'AlGONOA-508 001.

~t\hointed ~~ llV!t~fIf I~m~---

. .

"......... ..... .. "' ..'Whether inherited property ~f\ ~t\..(YesorNo)

(iv) Residential Buildings:(including apartments):-Location(s)~~ ~\ A-Surveynumberts)

Area (tolal measurement in sq.ft.) N~ ,'\ ~Built· up .area (To'tal measurement ."'-.A.. NA~~.ft.) . ~

Date of purchase in case of self- NA... f\..\Aacquired property . NACost of property (in····c;s~ ....of'", A: NApurchase) at the t.ime9fpurcf1(ls~ : -; " ....

.....

N,.(\

Approximate curI;.eritrria~Js~tvalue. t--..\ ~ ~ ~

(vi) Total of current market value of (i) ~ A.. M-A::i.tO(Y)(lpqye .

(8) I give herein below the details of liabilities/dues to public financial institutions and government:-

(Note: please give separate details of name of bank, institution, -entity or individual and amountbefore eac~!~em)

•..._ .._ _..••.._ .. _ _- ••. ,!:,.,,-,!:;::---..;._,_.. :.- _.__ :..•..•.... - : ; _.:._.. --::.'::""~'"

'·'.~A

'.' .,........ -.....•....

S"No,

Description Self Spouse Dependent-I Dependent-Z Dependent-S

r Lbihi'O't'dues to any other; Individuals/entity othermentioned aboveName(s), Amountnature of Joan

than''t\~

outstanding,

.....f\.~'.'."..~.1'.\~ .....~N~~A iMA

~A ~\1\..

'~1\ f'\~. .

t-..\ A ~'J\..

f'\A. ~'A-

Dues tofdepartment dealing with' N.~;supplyo water'Dues to department dealing with t..\ 1\supply of electricity 1,\ ~

. Dues to department de~ling with 't\ f:\. !, N~~ ~Il~l~ of telephones/mobtI~s...,~~ =l'C~department d~~~ngT'Eigr ~Dil.l·~ gave &t transport (iN~ ~W\

~

.~( NhrJLwvaff ~~d helicopters)

• ~ I -',wpo.rt,ed 0" l~' MOHO AR~~• '-:•..•,·0·' 'n'd '0 i., . . p~AD~E,

~\~ J~';~. , L B~ ~~ A V L ili~ ", ,~_' ./" ~41~ ~~/.'- , '. . A LLI' \

,,~lItA. t\~,' Off,. DDI) Vetenn~T\ ~OSOlta', M1G.VRoad..-~-- Manyam ?halka, NAlGONOA~508 001

&\pPO'"ted-.lW·~Govt-, df1NftJA

Income tax dues

NA NA N.A

(ivrWhether afly-~-th;r' Iiabilities are in . l'dispute, if so; mention the amount, ~ .' AN ..Ainvolved and the authority before "which it is pending. .,

.PART~B

(I J) ABSTRACT OF THE DETAILS GIVEN IN (1) TO (10) OF PART-A:

i 4. 'Name of the political party which set up thei candidate. (otherwise write .Tndependent')

Wealth tax dues

\...l.A N AService tax dues., - ..

Municipal/Property Tax dues N,.A N·A

~.A ··N·A

N·A.N,AN·A tv,AtJ·A N·A- '.... "';'

Sales Tax dues

N.A

(9) Details of profession or occupation:

(a) Self ..•.. r.:t.\~.~.1..9~~;:;;..(b) Spouse ..... B-:a~ ...~. {I.~:.

. ~ 1vJ-Q.J\,~d'N e.(10) My educational qualification is as under:- J!. f ~S· t~ ,'/tJ~ • - C{\ ~ l(\b t.J- )

Z?~~.....~.~.7."~!3,,,,~~.t,~,.~,.:~~:4,~.~:f~;~Q)1~I" .\-t,f Do~~. tJ~~ o~"~"o"VJ.'.~·~LO'~·'tJ~.- ~""LM.-VU" • -" ~ ~ •

(Give details of highest School/University education mentioning the fud form of thecertificate/diploma/degree course, name of the School/College/University and the year in which thecourse was completed.)

,'s <, ('6T~tal number ofpendi~g ca~e;'";h~re'~h~~~e~;'have been framed by the Court for offences'

i punishable with imprisonment for two years oil, more"" "C"~' ", .... M_' .•" ...-.'(ii) Total number of pending cases where thecourt(s) have taken cognizance [other than the

! cases mentioned in item(i) above];:'6"':' .,.... ." '. ,..".." ,'".,"" , , :' .~ '; Total Number of cases in which convicted and,

~ ~ sentenced to imprisonment for one year or more'~~~~ ~4 [~cept for offences refr/~fi,.~· IR~ctions

."~'y --"~i~2)or (3) of section g Of f{~ MMion of~~( t ~ople Act, 1951]. NO ARYQ IVOT~R'''- r' .- ..•,------------~------~ ..-":F ..• " r· ,• ..:~I~OI"~:dov ~.:; MOHD. A. J QUA~<~.o "n~ ;"Ir)) , '~~B"~+~ "- '. . A.1 C EflLAL)D

" ~.~,,." Ofk npp \fftterin;tr)' ~ospita'/Mui ~oad"';:o:!,!~. ~nyam ~halka! NAlGONOA-508 gO~

4000lOted .bv Gow. Itlt .~

9tv (L-'4

7.PAN of

Year for which last Total income shownincome Tax return filed

(a) Candidate "-~-R:' ' , ~t\ NA--- N~(b) Spouse .N N,f\(c) Dependents ,t--l ~ N ~ .. l'-\f\.

, . . .8. Details of Assets and Liabilities in Rupees.

Dependent-Il Dependent -IIIDescription Self '. Spouse Dependent-I--

A. Moveable Assets 5'/5001 ..... 500/- N.~ f\ N~(Total value) N., ' ... NA. ~A

..

~AB. Immovable Asset N+L N\-L____-. -_- :.._..c:.;._- .

C Purchase Price of self- N.1L }\~ N~ N~ N.f\acquired immovablept:~p:etty.

. ....II. Development! i' ! i

construction cost of w.IL t'nL1" NA N~immovable property f'\1\

after purchase (ifapplicable) -,-- -_.__ . ' ',:::;'",- .. -",

III. Approximate Current. N1L N'L NA ~A f'\~~arket price of- .. ...-- .....(a) self-acquired ~1L ~'L NA- N ~ ~~assets (Total Value) ... ,...: .. .. ..

H ••••• _ .. ' .... . ,"

(c) inherited NA,

N~ Nt\.~~$~ts_(Io!a!.y~!le) \:JrL N1L..

9., Liabll ities

(i) Government dues NL 'N l L ~~ NA N4\leEdfaf) ,-'-

(ii)".-- _. ... ••••••••• _"H. ..•.... ,

Loans from Bank. MI\- "'~ N~Financial Institutions N1L N'Land others (Total)

io,, ,-- _.

, Liabilities that are under9i~py!e(if Government dues f\"L ~tt N~ Nt\,(Total) ""rr L

"H.H ..

(ii) Loans-from Bank, ,;

Firiancial Institutions ~lL rlrl' ~'\ NI\ ~\ I

and.others (Total) .11 .' Highest educational qualification:

(Give details of highest School/University education mentioning the full form of thecertificate/diploma/degree course, name of the School/College/University and the year inwhich the course was completed.)

$ e1 ~ ~A~o-~ ul~~·q' ~ . .s ~v). N~. ~cL.-l~~i,

~OO\ - ~O\)\-"'S"6' cro\\ee~, ~~.

~oo4- ~ ~"'-~~ I ~~~,

NO ARY

MOHO. A

AVVOCA EOffi' Opp Veterinary Hospital. MlG. Road"'anyam Chalka, NAlGONDA-508 G8'I

~!miTIte9~ ~vt. fIf~

'.

/-I VERIFI CATl 0 N

J, the deponent, above named, do hereby verify and declare that the contents of this affidavit aretrue and correct to the best of my knowledge and belief and no part of it is false and noth ingmaterial has been concealed therefrom. I further declare that:-

(a) there is no case of conviction or pending case against me other than thosementioned in items 5 and 6 of Part A and B above;

(b) 1, my SPOlJSe, or my dependents do not have any asset pr liability, other than thosementioned ih items 7 ana 8 of Part A and items 8; 9 and 10 of Part B above.

" .-

p~=;:x;~::r::.;.N~.i~:,Th~'~~~~~',~Ie~~'~~~Pllfi~~~~~~~Qlhnqm~~!'O~f5.9.~ d'at~dth~lSiftApril. 19~JaQd:tast~e:'dedl:'iff(t'.~'~~~·' - ,, ,',' """"'-_,P..'_'_'~''< 1l." ..,~Q:pr

(I ) number $~~:7~$.Q3:Ji~,t~d.'m~i~ ;MaY'.2f)(rt.,(2)number S.O. 42$.(E) ~~e4)2~ld:~~.2:011.

II~-TESTEDIIN AFtV

"

MOHO- A RAVVOCATEB'~s-t~.BO).' J-al ')

Offi: Opp Veterinary Hospital MLG. Road\4anyam Ctlalka, NALGONDA-508 001

~ -by GM . .efl~'4

-8~