BIRTH DESCRIPTION

SIPB/503.24/280/BD/BPPTPM.03/IX/2014

REGISTRATION
: 052/DA/VII/2017
NUMBER
DAY : FRIDAY

DATE : 21st JULY 2017

TIME : 07.50 a.m

PLACE : CIAMIS

CHILD NO : 1st

GENDER : FEMALE

WEIGHT : 2900 GRAM

HEIGHT : 49 CM

NAMED : VIOLLIN CARISSA YUSUF MEDITERANIA

IDENTITY OF
PARENTS
MOTHER

NAME : YENIE SITI MARYAM

AGE : 35 YEARS OLD

OCCUPATION : HOUSEWIFE
DUSUN TIMBANGWINDU, RT 28 RW 10, PAMALAYAN VILLAGE,
ADDRESS :
CIJEUNGJING DISTRICT, CIAMIS REGENCY

FATHER

NAME : NUR YUSUF

AGE : 31 YEARS OLD

OCCUPATION : PRIVATE EMPLOYEES

DUSUN TIMBANGWINDU, RT 28 RW 10, PAMALAYAN VILLAGE,
ADDRESS :
CIJEUNGJING DISTRICT, CIAMIS REGENCY

CIAMIS, 21st JULY 2017

DEDE ASMARA, S.ST