\^!oike pmorihed hy Mule 8 , “ Besidenoy Orders 
Notification No. 11 , dated the 9 th February 1901 . 
1 
Notice No, 
Duplicate. 
\To he $eni forthioith to the ofioer appointed to eonduet the ten 
days’ ingpection.] 
\1, District 
'5. Station of issue 
is. Date of arrival 
4. Name of person 
0 , Father’s name 
is, Caste 
|6, Whence coming 
/r 
f9. Destination and residence^ 
\ daring the newt ten days | 
> (give district, taluq, ullage, ^ 
L street, and number or name \ 
j of the owner of the house.) J 
i'ou 
are 
required 
to present yourself for examination at 
from to 
both days 
mlusive, or submit yourself to medical inspection at your 
own house by a Oovernment Medical Officer, 
{Signed) 
I acknowledge receipt of this notice. 
Signature or mark of traveller, 
P.T.0 , 
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