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I

NSTRUMENDATASAKSI

Nomorper
kar
a :
.........
/Pdt...../
2021/
PA.
Pdg
Nama :
......................bi
n/bi
nti
...................
Tempat
/Tgl
Lahi
r :
.................................................
No.KTP :
.................................................
Jeni
s/Kel
ami
n :
.................................................
Agama :
.................................................
Per
ker
jaan :
.................................................
Pendi
dikan :
.................................................
Al
amat :
.................................................
Kel
urahan...............Kecamat
an................
Kot
a
HubungandenganPemohon/Penggugat:
..................................

I
NSTRUMENDATASAKSI

Nomorper
kar
a :
.........
/Pdt...../
2021/
PA.
Pdg
Nama :
......................bi
n/bi
nti
...................
Tempat
/Tgl
Lahi
r :
.................................................
No.KTP :
.................................................
Jeni
s/Kel
ami
n :
.................................................
Agama :
.................................................
Per
ker
jaan :
.................................................
Pendi
dikan :
.................................................
Al
amat :
.................................................
Kel
urahan...............Kecamat
an................
Kot
a
HubungandenganPemohon/Penggugat:
..................................

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