FORM OF APPEAL TO THE APPELLATE AUTHORITY

See rule 4.4. Appeal No4. I I44$ 4I8H4 I4S 44j4HI 4I*I44 Of ZO.. S hri .4 Son of Shr Resident 01 •t1u,t,1tU414tflhfl4flt14411 !t.IflP! •!!n!fl*W'•' .n1*.t$*.1Ilp*I..t...,t.I.. a, pa .q..,p,a,.,n.., A)pe lLiit. Versus. Noniinted AuthorityIL)r&cto r/St b DivsonaJ Mgbt rdteRe5po n dent. Appeal under section. .. a of Ngard gainC the notice/order of 5hr.. H Nominated AuthoriLfSub D ional t1aistrate/Director dated; 4444. Sir,. The Appellant respecifully shwtPi it., under:- 1, Statement of facts. L Groundofappeal. .3. Fee of Rs 5000/ has been paid vide receipt No. 4,...M•fl. dated .. ........ 4. Appeal is within time,. S. No other Appeal or 4oy matter relating to the subject matter of this ppe3l many court of law. 6. Relief dairned.. Signature of Authorized represetitatht 1 if any, $inature of AppefiJr%t. VIFKAT IC N. I 444,44.4. 44 4 The appellant do here y declare that what is stated above is iruc to the best of my personal knawed.e and belief and that! have not suppcessd inymaterial facts. Verified to6y1 the .....t.....day of 2O,.... Sienature of Authorized rpree ntativ, if any, Sinatu re of Appellant