FORM NO. 61
( See proviso to clause (a) of Rule 114C )

Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified in clauses (a) to (h) or Rule 114B

1.	Full Name And Address
	of the Declarant
2.	Particulars of the transaction
3.  Details of the 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.

VERIFICATION

I,                                                                                                              do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the                                day of                                19     .

INSTRUCTIONS

Documents which can be produced in support of the address are :-

• Ration card
• Passport
• Driving license
• Identity card issued by any institution
• Copy of the electricity bill or telephone bill showing residential address
• Any document or communication issued by any authority of Central Government, State Government or local bodies showing residential address
• Any other documentary evidence in support of his address given in the declaration.