Example of ORIGINAL Copy

N. B. Will take receipt, in the time Counter Foil (1) How much number, (2) How much money and (3) How much quarter is written, will be compared with the receipt. If be difference of the receipt will be inform

Form No. 1646 Circle No. ........ Ward No.-86

ORIGINAL (Receipt Form) (There will be double written with carbon) (Dhaka City Corporation)

(Monogram) Receipt No. A 164501

Receipt Book No.                     KA – 10/3, Kalachandpur                                                           Assessee No. 5032

Holding No. & Mahalla               MRS. JAHERA BEGUM

Received the sum of taka : 3154/- (in word) : Three thousand one hundred fifty four taka on account of City Corporation rates as per details below :

	Old Arrears		Previous Year 2005-2006				Current Year 2006-2007
			1st Quarter	2nd Quarter	3rd  Quarter	4th  Quarter	1st Quarter	2nd Quarter	3rd  Quarter	4th  Quarter
	Period	Amount	Amount	Amount	Amount	Amount	Amount	Amount	Amount	Amount	Total
Holding rate						511/-	511/-	511/-	511/-	511/-	2044/-
Conservancy rate						146/-	146/-	146/-	146/-	146/-	584/-
Surcharge						-	-	-	-	-
Lighting rate						219/-	219/-	219/-	219/-	219/-	876/-
Total taka :	3,154/-									R -

Date : ...........................

Sd/- Illegible 12/3/06 Mir Abdus Samad Revenue Supervisor Revenue Zone – 9 (Gulshan) Dhaka City Corporation

Sd/- Illegible Chief Revenue Officer For Dhaka City Corporation [by seal]