Nomorinduk kependudukan Par Re = : 1809070111510002 REPUBLIK INDONESIA REGISTRY OFFICE INDONESIA NATIONALITY INDONESIA EXCERPT OF DEATH CERTIFICATE Retdasarian Akta Kematian Nomor -—«1809-KM-05052021-0001 By virtue of Death Certificate Number menurut sitld bahwa di KEDONDONG: in accordance with state gaezette that in Radatanggal ENAM MARET on date THE SDH OF maRcH fahun =—-_ DUA RIBU DUA PULUH SATU year TWO THOUSAND AND TWENTY-ONE telah meninggal dunia seorang bemama Th/Ny/Nn FATHULLAH SAPUTRA @ person has deceased by name of Mr/Mrs/Miss lahicdi © KEDONDONG bom in SATU NOVEMBER on date THE FIRST OF NOVEMBER tahun = SERIBU Sent RATUS LIMA PULUH SATU year ‘NINETEEN FIFTY- PESAWARAN The excerpt is issued ala Tanggal LIMA MEI DUA RIEU DUA PULUH SATU _-F MAY TWO THOUSAND AND TWENTY-< call PESAWARAN