w o m a n

KUTIPAN AKTA NIKAHSERI: FA

a
wanita / to
SITI 2AHMAH S.E
EXCERPT OF MARRIAGE
s e o r a n g

Dengan
* * * * *

******* *************************** ****

Nomor I Number
Pada hari /I
Day
6 3,CERTIFICATE
X ao11 name

Tanggal, S4BTU
bulan, tahun: 2SEPT. ****************
1.
Nama
/Full Hi 2usDI
39OET:
1987
Date, Month, Year 20 ***** 2. Binti/Daughterof
lahir /
PoSO
Bertepatan /Or MAC &
tanggal

Pukul At
Tempat
birth HDONESIA **

3. date
of

I9.ooITA
and
Place
Nationality: * * * *

******** / 1SLAM. **"

****.. H W a r g a n e g a r a

****..
Telah ************s 4. PetANAN.
dilangsungkan
There has been akad nikah
seorang laki-laki: 6
5.
Agama
S t a t u s
/
s
Religion

e b e l u m n y a /

authenticated
DesA a664W1A

a marriage *******************************
covenant of stalus prior
1. Nama/ Full mariage of a man:
Marital

name FARID USMAN

i** S.ST
*******************************************
Alamat/Address
************
**

. * * *

2.Bin/Son of PECaNA BUmad

3,
Termpat &tarnggal tahir
SAID USHAN
************* Occupation

Place and date of

birth
OS ****

0 MEI 1O8
*******************
8.
Pekerjaan

dengan
/

wali nikah
/with wedding
guardian
PuaC
*******

4:Warganegara/ Nationality IHDONES14 1.

Nama/ Full name
5.
Agama I Religion ******************************
1SLAM **** **** TolLB4 131 19s4
6. Status sebelumnya/ ******** ssneuu *********** lahir /
2. Tempat tanggal
Mantal status prior **** **************
Place and
date of birth
IHDONESIA
mamiage ******
7.Alamat/Address Poso ***
*****
3. Warganegara/Nationality:
sLAM
* *******
*** **
*********e
************************************************
4. Agama /Religion DesA NGGaN14
5. Alamat / Address
** ****************************************
8. Pekerjaan/ Occupation
PHS A

****************************#*****************************5
6. Pekerjaan/ Occupation
PeNSIurAN PNs
* * * * * r r