FORM NO. 61
[See provisio to clause (a) of rule 114C(1)]
Form of declaration to be filed by a person who has agricultural income and is not in
receipt of any other income chargable to income-tax in respect of transactions
specified in clauses (a) to (h) of rule 114B
1. Full name and address of the declarant …………………………………………………………………………………….
……………………………………………………………………………………………………………………………………………..
……………………………………………………………………………………………………………………………………………..
2. Particulars of transaction
3. Details of documents being produced in support of address in column(1) Yes/No
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.
Verify today, the …………………………….. day of …………………..
Date :……………………..
Place :……………………………..
……………………………………………………….
Signature of the declarant
Instructions: Documents which can be produced in support of the address are :-
(a) Ration Card
(b) Passport
(c) Driving licence
(d) Identity Card issued by an institution
(e) Copy of the electricity bill or telephone bill whoing residential address
(f) Any document or communication issued by an authority of Central Government, State Government
or local bodies showing residential address.
(g) Any other documentary evidence in support of his address given in the declaration.