“Form – IV (see rule 7) Statement of Assets and ... - Lokayukta

7. Liabilities as on 31 st March...........a) Nature, extent andother particulars ofliability and the datewhen it was incurredb) Name and addressof the person to whom(creditor) liableI, .....................................................................................do hereby solemnlydeclare that the information furnished above is true and that nothing relevant hasbeen omitted therefrom.Station:Date :Signature of the Public ServantDesignation .............................