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Nomor Induk Kependudukan. 1604220606010001

Pmon11el Registration Number· No.AL.5860089205

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PENCATATAN SIPIL
REGISTRY OFFICE

WARGA NEGARA 1.N.D..0.N..E..S.J.A........... .

NATIONALITY INDONESIAN
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KUTIPAN AK.TA KELAHIRAN

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EXCERPT OF BIRTH CERTIFICATE
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Berdasarkan Akta Kelahiran Nomor 1.~Q~H,..I:.1.1.1.Q.1.QJt:P.P.i~ ............................................................. .
By virtue of Birth Certificate Number
menurut stbld
in accordance with state gazette .
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bahwa di .!~~~~~.~.~Y~~.............................. pa1~tanggal .. J;N~M ......................................... . ~'

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that in on a SIX

X~~ . . . . . . . . . . ~~~ ·~~~.~~o~U~~~~·o'NE··· .. ········· .. ······· .. ······················· .. ·········· ~~~1Jol~ : r· _I

................................................ AGJ.L.DEPRl.H.END1KA ...................................................... . 1T1

anak ke ~TIJ., ~Kl~ RARI ~:YAH.Ol.01.S.UJ:WNIDAN IBU J:IESTIKA.OEKTARIANI................................ .

child no FIRST, MALE FROM FATHER DIDI SUHAIMI AND MOTHER HEST/KA DEKTARIANI

Kutipan ini dikeluarkan .. .tll.KAB •.1.Af:tA.T..... .... .

The excerpt is issued
pada tanggal ... ~t;e,fJ.AS..QKI08fR ................ .
on date ELEVEN of OCTOBER
TAH.UN..DUA.RJBU.SEBELAS............................... .
~ Y~R TWO THOUSAND ELEVEN
~ OINAS.KEP.ENDUD1JKAN.0AN .............. .
Heiiifof PE..11,CATATAN SIPIL KAB. LAHAT

H. A MUCHTAR EFFENDI ALI. SE. MM

NIP:195810121980031010

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