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IKATAN KELUARGA KATOLIK SUMATERA UTARA

(IKKSU)
PAROKI KRANJI ST. MIKAEL BEKASI

FORM DATA KELUARGA

BEKASI, TGL .............. BLN .............. THN ..............
STATUS DALAM
NO NAMA LENGKAP TEMPAT TGL. LAHIR
KELUARGA
1.

10.

ALAMAT RUMAH : ..............................................................................................................................................

..............................................................................................................................................
WILAYAH : ..............................................................................................................................................

IKATAN KELUARGA KATOLIK SUMATERA UTARA

(IKKSU)
PAROKI KRANJI ST. MIKAEL BEKASI

FORM DATA KELUARGA

BEKASI, TGL .............. BLN .............. THN ..............
STATUS DALAM
NO NAMA LENGKAP TEMPAT TGL. LAHIR
KELUARGA
1.

10.

ALAMAT RUMAH : ..............................................................................................................................................

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