Form C

[Rule 11]

To
..................................residing in......................Village....................................Taluk

Whereas you are found to be in unauthorised occupation of the land specified in the schedule below, which is poramboke/the property of Government other than poramboke you are hereby required to vacate the land within............days from the date of service of this notice, failing which you will be summarily evicted from the land and any crop or other product raised on the land and any building or other construction erected or anything deposited thereon shall be held liable to forfeiture.

Village Sy. No. and sub-division No. Description of land Entire extent A.C. Occupied extent A.C. Nature of occupation
           
           

Amount of fine
Amount of assessment
Period for which arrears of assessment is charged
Amount of arrears
Total amount due.

Take notice also that the....................Village officer is hereby authorised to carry out the eviction and to take possession of, land retain in proper custody, anything on the land which is liable to forfeiture pending the Collector's order as to its disposal.