Sample or Example of Receipt

Bangladesh Form No.1077 (Revised  2006)                                                     Serial No. U 233336

LAND DEVELOPMENT TAX PAID RECEIPT

City Corporation/P.O./Union Land Office name : Demra Land Office

Name of the Mouza : Jatrabair, J.L. No. 17, Upazila : Demra, Dist. Dhaka, Name of the Owner : Md. Ayubur Rahman, 2 No. Registrar and as per of it holding Number and Address : 2526

..............................................................................Type of land.............................Ledger No. 25/-

Plot No. 774 ...............................................................................................Amount of Land 0495

For which year demand is paid	Description of collection				Remarks
	Land Development tax	Interest	Miscellaneous	Total
1409-1416	875/-	105/-	--	980/-

                                                 

N.B. If be paid the Land Development Tax by the cheque its description if as the following.

Total taka :  In word : Nine hundred eight taka only

For the year 1409 – 1416

Name and Signature of the Depositor

Sd/Illegible Name and Signature of the Collector Designation : Dated : 29/05/07

Ordinance No.16/2005-06.................Dated :8-12-05

BGP Form Identification.