FORM 28 NoMI$i;.$iI4]APER Election to the l,egislative Assembly of Andha Pradesh (State) Recenl strmn I S\No'".. tt .Q {rnJt .*nn9 \)'" -fih\^r\ STRIKE OFF PART I OR PART II BELOW WHICHEVER IS NOT APPLICABLE PAIIT I (To be used by candidate set up by recognised political party) I nominate as a candidate fbr election to the Legislative Assembly fron the 115- Atmakur Assembly Constituency. Candidate's name Mekapati Srikirti Fat+€rhlnto$€rl#husband's name Mekapati Goutham Reddy His postal address 2-23-A, Bramhannapalli, MarriPadu Mandal' SI'SR.Nellorc Dist / IIer name is entered at Sl. No323 in Part NoS ofthe electoral roll ibr I ls-Atmakur Assembly constituency. My name is Kausalyamms Koduru and it is entered at Sl. No. 941 in Part No 128 ofthe el<croml roll lor the Almakur Assembly constituency. J< 'fou+."\--,.*^-a Date 25.03.2019 Sigrature of the Proposer TII We herebv nominate as candidate ction to the Legislative Assembly from 1he...........)\............,..........Assemb1y ituency. Candidate's r'Vhusband's n.rme............................)1............1 lis po'tal address .......................................His i,a entered at Sl. No................in Part No................o electoral roll tbr ......Assembly constituency. we declare that we are electors of this Assembli tuency and our ntunes are en ir: thc clectoral roll for this Assembly constituency as indi and we appcnd our s below in token oIsubscribing lo this nomination: - Prrticuhrs proposers xnd their signatures S.N\ Elcctor Roll No. of Prop\er FullName Signature Date Part No.of S.No.in th\ Electoral Roll Dart 6 1 2 \ ) 1. ) 3. 4. OT APPLICA.B 5. 6. 7. 8. 9. 10. N.B.- There should bc ten electors ofthe constituency as PART III l, the candidate mentioned in Part VPart-+I (Strike out which is not applicable) assent to rhis nomination and hereby declare that- (a) I am a citizen oflndia and have not acquired the citizenship ofany foreign State; (b) that I have completed 47 years ofaBe; [STRIKE OUT c(i) OR c(ii) BELOW WHICHEVER IS NOT APPLICABLE] (c) (i) I am set up at this election by the Yuvajana Sramika Rythu Congress party, which is recognized Natioaal*ary/State Pa(y in this State and that the symbol reserved for the above party be allotted to me. OR is-€ @ (d) my name and my father'Vflre+h€f.s/+tlsband+name have been correctly spelt out above in English (name ofthe language); and (e) That to the best ofmy knowledge and belief, t am qualified and not also disqualified for being chosen to fill the seat in the Legislative Assembly ofthis State. * I further de€lare that I am a mem **easte,/tribe efthe State ef,,,,,,,,,,,,,,,,,,,,,,,,,in rel&tion te,,,,,,,,,,.,,,,,,,,.,,.,,,,,(area) in tha'State- Carididate Datc 25.03.2019 ;36Eiut tt it pu.ag.aph, ifnot applicable. ** Score out the words not applicable. bY the Election N.B.-A "recognised political party" means a political party recognised Commission under the Election Symbols (Reservation and Allotment) Order, 1968 in the State concerned PART IIIA (To be frlled bY the candidate) ( I ) Whether the candidate- (i) has been convicted- (a) of any offence(s) under sub-section (l ); or Yes,No (b) for contravention ofany law specified in sub-section (2) of section 8 of the Representation of the People Act, I 95 I (43 of l95l); or has been (ii) has been convicted for any other offenae(s) for which he sentenced to imprisonment for two years or more' ,'Yes',. information: Not Applicable lfthe answer is the candidate shall furnislr the following (i) Case/First information repofi No /Nos Nil (ii) Police station(s)NllDistrict(s) NlLstate(s)!!! ofthe offence(s) for which iiiil Sectionlsl of the conc€med Act(s) and briefdescription he has been convicted $! (iv) Date(s) ofconvictioD(s) Ni! (v) Coun(s) which convicted the candidateli! and/or quantam of (vi) punisnmentG) irnposed [indicate period of imprisonment(s) fine(s)l Nil (vii) Date(s) of release from prison!! No YeeNo (nlii) WuJ*"," uny uppeal(s)/revision(s) filed against above conviction(s) for revision^filcd Nil iixl Dat. and paticulars ofthe appeal(s)/application$) i*iNu.. ofth" before which thc appeal(s)/application(s) for revision filedli! "or.t(s) disposed ofor (xi) Whlther the said appeal(s)/application(s) for revision has/have been is/are Pending{!! been disposed of- (xii) tf the said appeal(s)/application(s) for revision has'/have (a) Date(s) of disposalni! (b) Nature of order(s) Passednj! Govemment oflndia or (2) whether the candidate is holding any office ofprofit under the State Goverrnnent? No (YesNo) lf Yes, details of the office held!!! No (Yes/No) (3) Whether the candidate has been declared insolvent by any Court? JfYes, has he been discharged from insolvency Nil foreiSn country? No (Ye&4''lo) (4) Whether the candidate is under allegiance or adherence to any -lfYes, give detailsM said Act by an order of (5) whether the candidate has been disqualified under section 8A ofthe the President? No (YesA''lo) -lfYes, the period for which disqualified !!! holdirg office (6) whether the-candidate was dismissed for corruption or for disloyalty while No (YesNo) under the Govemnent oflndia or the Government of any State? -lfYes, the date ofsuch dismissal $!! either in (7) Whether the candidate has any subsisting contract(s) with the Goverrunent share for supply of individual capacity or by trust or partnership in which the candidate has a by that any goods to that Government or for execution ofworks undertaken Govemment? Yes (YesAle) Enclosed -lfYes, with which Government and details ofsubsisting contract(s) ' Secretary ofany company or (8) Whether the candidate is a managing agent, or manager or ofwhich the Central/ Corporation (other than a cooperative society) in the capital percent share? No Government or State Government has not less than twenty-five (Yes/no) lfYes, with which Govemment and the details thereofNi! under section l0A ofthe (9) Whether the candidate has been disqualified by the Commission Said Act No (Yee4"lo) lfyes, the date ofdisqualification Ni! / /// Place: Atmakur ?" /0' Signafre oi the candidate Date:20.03.2019 PART IV (To be filled by the Retuming Officer) paper.Pf,... .. Serial No. ofnomination r-s- g.ldl . L(aate) uy This nomination was delivered to me at my office at tl' \$ 1hour) onl l the *candidate/Plopdrr (Name), oate.2..5.93fJRetuming offl cer rscore out the word not applicable. PART V Dccisiod of Returning Officer Accepting or Rejecting the Nomioation Paper I have examined this nomination paper in accordance with section 36 of the Represeltation ol the People Act, 1951 and decide as follows: - Dalc Returning Otficer FORM A NAMES OF CANDIDATES SET TO AUTHORISED PERSONS TO INTIMATT COMMUNICATION wlTH REGARD P.LITI.AL ooi''*t PARTY oR REGISTERED up By REcoGNtsED NAT'.NAL oR ttn'i 'N-R[.,GNISED PARTY. lhe Eleclion Svnrb'rh iS' par agraph 13{' ) (Ll) an'l tt'}')l " Order' 1968 1 tRe(ervalion dnd Allolnr(nl) To 1. 'Ihu Chief Electoraloficer' Andhra Pradesh (State/U{i6n4errit€ry) 2. The Returning officer for the cy t 15 _ Atmakur Ass€mbly Constitue ' ftorl Isdcillslol"/u$€f,f+Fd€ry) Gencml Elc'1ionslo kgislot'veA $cmbly Aulhl Subiect nanes of candidales' _ uf p*rson' t intimate Allolment ol Symbots Authorisation tn and Allotment) 0rdcr' (() (d) and..le)(el of *:the Election s)T nbols [Reservatio' in'r,o*n." o[ parasraph 13 'd ' :1']'l"ll "J5;""'';; ;urhorised hy wvAlANA 1968'lherehyCommunicatethatthefollowlngporsonl,has/havebecnaupartv in the stot€ of fdfuglu!!fi pemv' rs d*o}+Giso* RYTIIU coNcncss wrrlcri be set up hy rh. SMMIKA t" ttd"-;;i;; of d'" candidates Propced to $egis$4+an-'"€ag&i**+'4' -n'"t District(s)/area [s) constituerrcy'/ Name of office held in the conslituencies in respect ol Name of Person authorised to party has been authoriscd' send notic€ whict he 3 115 - Atmakur AssemblY PARIY PRTSIDENT Con*ituenc1, Andhra Pradesh 1. Y.S.IAGAN MOIIAN REDDY The specim c I sig natu res of the above mentioned person ( s) so a utho rised a re Sive n below:_ 1. sperinxjr signatures of Shri y.S. rAGAN M0HAN REDDY \\\") .......1\.-- (ti) u\"4..... (iii) ........ .d=........... t0 u\q*---*. (G.......:............. 2. Spe( irr)eD signatures of Shri tD .. .....................-............. (i, ................................... [iiD :t. Sl)( rrx'r srljllaturcs of Shri i0 tii) ''..,',..-,..-,...,...,..,...,,',.. (iiD r\\Youlr;faithfully, \\,_\v) (v.s. lnear koxln aroovl hr*ia.nt Yuvajana Sramika Rrthu Congress Party Place: Hyderabad, .,..:-*;;,,:;.:,, Dat€: 18.03.2019 /i1ir-'- \r\. il.'l,r,otul? ll li'r':+,9 !-\ tb it (Seal of thc Party) NB, 1. This must be delivered to the Returning Officer and the Chief Electoral0fncer not later than 3 p.m. on the lastdate formakihg nominations. 2. Form must bc signed i n ink by the offi ce bearer (s) mentio ned above. No facsim ile signature or signatureby means of rubber stamp, etc., ofany omce bearer shall be accepted. 3. No form traosmitted by hx shall be accepted. FORM B SET UP BY THE POLITICAL PARTY NOTICE AS TO NAME OF CANDIDATE Allotment) (e)and l3aofthe Election symbols (Reservation and Isee paragraphs l3 {b}, (c) and Order 1958) To The Returning Officer for the 115 - Atmakur ConstituencY' from AssemblY constituencY subiect:_ General/bYe tlection to Leeislatlve Assemblv 1l!9:_l\!I!4!g! '""'"''" o"li."'"*o*n (state/uf,ie'6+ei+itoq) -sellrn8 up of Landrdate' t'J the I le(lion symbol}-(Reservation and ou,rr"nr" of purrg,"phs 13 {b), (c} and (e) and 13A ol SRAMIKA RYTHU coNGREss li,l,.""ii",a"i.