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Please pay to ________ the sum of Rs _______(in figures) Rs.______(in words) Signature ______ Designation ________ Date ______ X LAWS IN M.P. Treasury Officer Treasury Officer Vr.No. ________Date of encashment in the Government Treasury _______ Date of encashment in the Government Treasury _______ /sub-treasury________pay Rs.______ only. Signature_______ Treasury /sub-treasury officer Claimant's Signature and Date _____ Treasury/sub-treasury Officer. Date of encashment in the Government Treasury _______ /sub-treasury________pay Rs.______ only. Signature_______ Treasury /sub-treasury officer Claimant's Signature and Date _____ Treasury/sub-treasury Officer. To, The Profession Tax Assessing Authority, This is to certify that the refund of Rs.______ as per your refund payment order, dated _________ book No. ________ Vr./ No. _________ has been made on ______ (date) Dated--------- Treasury/Sub-treasury Officer FORM – 19 (See rule 22(3)) Refund adjustment order Book No. __________________________ Vr. No. _____________ To, The Treasury/ sub-treasury officer __________ Certified that with reference to the assessment record of ______(Name) bearing registration certificate No. _______ for he period from ______ to ______ a refund of Rs. _______ is due to _______ (Name)