KEPOLISIAN NEGARA REPUBLIK. INDONESIA
RESOR KOTA BESAR MEDAN Nomor : 02-02
SEKTOR SUNGGAL
— Jalan 1B.Simatupang No.240 Sunggal 20128 __
‘SURAT KETERANGAN CATATAN KEPOLISIAN
POLICE RECORD.
Nomor: SKCK/ YANMAS / 5283 / X/2019 /INTELKAM
Diterangkan bersama
‘This sto certify that
Nami : OPTARI DWITYA LARASATI
Name
Jenis kelam PEREMPUAN
Sex
Kebangsaan INDONESIA.
Nationality
Agams ISLAM
Religion
‘Tempat dan tangge!lahie MEDAN KRIO, 21 JANUARI 1998
Place and date of birth
— ayy
Petciaan manny
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