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PENCAI:{XIAN SIPIL
REGISTRY OFFICE
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EXCERPT OE BIRTH CERTIFICATE

Berdasarkan Akta Kel4hq4aNq11q ..Sp'f*f.:t$t t3SrI.*S90.

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in accordance zoith state gazette
bahr.t,a di ..gAffUI pa4a tanggal ....$.Effifl6;
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F_EnRgS!......... tahun .pLrA. RE}.U. telah lahir +1


FEBRIIARY ONYCdf TWO THOUSAND zoGTorn
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