KGis 001 KOGI STATE OF NIGERIA KOGI STATE GEOGRAPHIC INFORMATION SYSTEM (GIS) & APPLICATION FOR RECERTIFICATION OF STATUTORY LAND TITLES Applicant <= asta. 5 Se Ss 2 peg: Contact Address:. (©) State: (© Phone No 3 SO = Male(—_£Femalef—]____single—]__*Wiarried—J_ Next of Kin: “Kddress of Next of Kin: Type of Grant (a) Conversion. (b) Statutory Right of Occupancy Kg No-=2(¢) Cert panty (C of 0) Kg: No: (d) Date of Grant; Block No: Plot No: is _ Size of Plot: Is the property assigned to you? If yes state the name of the assignor and type whether Part(_Jor Full] Attach evidence of payment of ground rent up-to-date. : please submit all the necessary land documents relating to your land Title Signature: Date:DECLARATION Tas. in this form are true and correct. ...hereby declare that all the information supplied Usual Signature or Thumb Print of the Applicant or Attomey FOR OFFICIAL USE ONLY. (i) File Reference... (ii) Application Fee Paid Vide Receipt No...... (ii) Date Received... (iv) Recommended by Director of Lands... (v) Approved by the Permanent Secretary...