FORM NO. 61
[See proviso to clause (a) of rule 114C(1)]
Form of declaration to be filed by a person who has agricultural income and is not in receipt of any other income chargeable to income-tax in respect of transactions specified rule 114B

1. Full name and address of the declarant _______________________________________________________
2. Particulars of transaction ___________________________________________________________________
3. Details of documents being produced in support of address in column (1) Yes /No
I hereby declare that my source of income is from agriculture and I am not required to pay income-tax on any other income if any.
Date : _________________
Place : ________________ Signature of the declarant
Verification
I, ____________________________________________________________ do hereby declare that what is stated above is true to the best of my knowledge and belief.
Verified today, the ________________ day of ______________.
Place : _________________
Signature of the declarant
Instructions : Documents which can be produced in support of the address are :-
(a) Ration Card
(b) Passport
(c) Driving licence
(d) Identity Card issued by any institution
(e) Copy of the electricity bill or telephone bill showing residential address
(f) Any document or communication issued by any authority of Central Government, State Government or local bodies showing residential address
(g) Any other documentary evidence in support of his address given in the declaration.