Form No. A-75 No . FORM FOR DECLARATION BY OWNER / LESSEE / HUT OWNER / PERSON LIABLE TO PAY THE CONSOLIDATED RATE IN CONNECTION WITH APPLICATION FOR RECONSIDERATION OF VALUATION DUE TO CHANGE OF OCCUPANCY I / We, Sri/ Smt. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .the recorded owner / lessee / hut owner / person liable to pay tax of the Premises No.. . . . . . . . . . . . . . . . . .. .. . Wd.No.. .. . . / Assessee No.. . . . . .. ... do hereby declare and affirm : 1. That the above noted premises which was let out to Sri / Smt . . . . . . . . . . .. . . . . . . . . . . . . . . . at a monthly rental of Rs. . . . . . is now under my / our exclusive use and occupation with effect from .. . . . . . . . . . . . 2. Thatthepremises/flaton the .. . . . . . . . . . . . . .floor of thepremises shall henceforth be exclusively used and occupied by me / us for my / our exclusive use only. 3. That I / We agree, declare and undertake that :a) ThePremises/flatonthe..................floorofthe premises is not intend to be let out. b) In case of any subsequent change in use or nature of use of the premises or portion of the premise referred to above, I / We shall inform in writing to the Municipal Commissioner within fifteen days of such change and also submit a return in accordance with section 182 of the KMC Act, 1980. c) In case of omission to inform the Municipal Commissioner as aforesaid the Municipal Commissioner shall be at liberty to revise the assessment of the premises or portion thereof in accordance with section 180 read with Section 192 of the KMC Act, 1980, with effect from the date of this declaration. Enclo:-Xerox Copy of current paid Tax bill Signature of the Owner / Lessee / Hut Owner / Person liable to pay tax of the premises No. . . . . . . . . . . . . . . . . Assessee No.. . . . . . . . . . . . .
