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  • Suket Kematian

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    Bani Hasyim
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    SUKET KEMATIAN

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    8 views2 pages

    Suket Kematian

    Uploaded by

    Bani Hasyim

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 2
    JANG PEMERINTAH KABUPATEN PANDES KECAMATAN SUMUR DESA KERTAJAYA SUMATKETERANGAS KEMATIAN Nomor 07 (Dx. 206212023 Yang bertanda tenpan dibreah imi Kepala Dew Kertajaya Kecamatan Sumur Kabupaten Pandeglang, mencranphan dengan wewnggubmya bahwa Name AMSORL MK AVON 208 920001 Teenpat Tanpgal Labor Pandeplang, 05-10-1965 Jems Kelaenin abidales Agen Ietarn Alarnat Kp Maxgid RT/RW 002004 Dos Kertapeys Kecamatan Surtur Kabupaten Pandeglang, Narn teruebrt di stat telah meninggal dunia pda Het Rats Tanga Meninggal 15 September 2021 Teropat Di Rumah Desa Kertajaya Kecamatan Summur Kabupaten Pandeglang, Seba Karena Sakit Demnibise eueat heterangat Kernatian it hams baat ates dasat laporan dari Anak almarhurn dan Kets KT! BO seteenpet dan kepada yang bersanghutan hami mobon bantuanay Dipindsi dengan CamScanner Personel Registration Number Nomor Induk kependudukan / endudukan —- 3601011205580001 REPUBLIK INDONESIA PENCATATAN SIPIL REGISTRY OFFICE WARGA NEGARA INDONESIA NATIONALITY INDONESIA KUTIPAN AKTA KEMATIAN. EXCERPT OF DEATH CERTIFICATE 3601-KM-17092021-0009 By virtue of Death Certificate Number menurut stold bahwadi RUMAH in accordance with state gaezette that in ‘SEPTEMBER pada tanggal LIMA BELAS ‘SEPTEMBER on date tahun year ‘THE FIFTEENTH OF UA RIBU DUA PULUH SATU WO THOUSAND AND TWENTY-ONE ia seorang bemama TniNyiNn AMSOR! ‘a person has deceased by name of Mr/Mrs/Miss lahir dt born in on date abun year PANDEGLANG ‘OKTOBER LIMA, OCTOBER ‘THE FIFTH OF [SERIBU SEMBILAN RATUS LIMA PULUH LIMA NINETEEN FIFTY-FIVE Kutipan in cikeWarken Di PANDEGLANG. The excerpt is issued Pada Tanggal TUJUH BELAS SEPTEMBER DUA RIBU DUA PULUH SATU (n date THE SEVENTEENTH OF SEPTEMBER TWO THOUSAND AND TWENTY-ONE KABUPATEN PANDEGLANG Ofcer of Civil Registration : er Dokumen ini telah ditandatangani secara elektronik menggunakan sertifkat elektronik yang

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