FORMULIR KEMATIAN DI DESA

Desa : ANCOL
Kecamatan : CINEAM
NAMA DAN NO. HP KELUARGA YANG
NO NIK NAMA LENGKAP TEMPAT DAN TANGGAL LAHIR TEMPAT DAN TANGGAL MENINGGAL NAMA PELAPOR NIK PELAPOR
DAPAT DIHUBUNGI
1 2 3 4 5 6 7 8
1 3206202402080432 AROH TASIKMALAYA, 11/10/1961 PANAEKAN, 15/01/2021 YAYAT 3206200301780001 YAYAT (085792920733)
2 3206202302080351 ELIZA NUR AZIZAH BANJAR, 12/08/2003 MARIBAYA, 07/01/2021 JUMIATI, SH 3206204101830009 JUMIATI (085321000314)
3 3206200507520005 SATAM CIAMIS, 05-07-1952 PANAEKAN SUSI SUANTI 3206205006890003 SUSI (085223587021)
4 3206204107430026 ICIH TASIKMALAYA, 01-07-1943 MARIBAYA, 14/02/2021 KOMAR SB 3206200507550015 KOMAR (082310778856)
5 3206200107330059 ENI SALAM TASIKMALAYA, 01-07-1933 PANAEKAN, 29/03/2021 YOGA RAHAYU 3206202007900002 YOGA (082315859446)
6 3206200107450390 MUSLIH TASIKMALAYA, 01-07-1945 MARIBAYA, 31/03/2021 LILIS LISMAYANI 3206206705800001 LILIS (082320332729)
7 3206203112270001 KARMAN TASIKMALAYA, 31-12-1927 PANAEKAN, 06/04/2021 RIFKI ARIPATULOH 3206200107930056 RIFKI (085220896679)
8 3206201705300002 SAHMAD TASIKMALAYA, 17-05-1930 PANAEKAN , 07/04/2021 RIFKI ARIPATULOH 3206200107930056 RIFKI (085220896679)
9 3206204107450310 HAPSIAH TASIKMALAYA, 01/07/1945 MARIBAYA, 21/04/2021 LILIS LISMAYANI 3206206705800001 LILIS (082320332729)
10 3206204610600004 ENTIN TASIKMALAYA, 06-10-1960 PANAEKAN, YOGA RAHAYU 3206202007900002 YOGA (082315859446)
11 3206205911380001 EUNEUNG TASIKMALAYA, 19-11-1938 PANAEKAN, 22/05/2021 RIFKI ARIPATULOH 3206200107930056 RIFKI (085220896679)
12 3206204609510001 ANAH TASIKMALAYA, 06-09-1953 ANCOL YANA 3206201007690001 YANA (082318430011)
13 3206200107730006 YAYAN TASIKMALAYA, 30-09-1973 MARIBAYA, 18/06/2021 KOMAR SB 3206200507550015 KOMAR (082310778856)
14 3206201311360001 ABNAN TASIKMALAYA, 13-11-1936 ANCOL,26/06/2021 KIKI AMELIA 3206206405810003 KIKI (082113995501)
15 3206205403560003 IDOH TASIKMALAYA, 14-03-1956 ANCOL, 16/07/2021 NANDANG S 3206201408590001 NANDANG (082247549241)
16 3206200902340001 HANAPI TASIKMALAYA, 09-02-1934 PANAEKAN YAYAT 3206200301780001 YAYAT (085792920733)
17 3206202302080234 IMI TASIKMALAYA, 01-07-1947 MARIBAYA, 01/08/2021 KOMAR SB 3206200507550015 KOMAR (082310778856)
18 3206204107380104 ALIYAH TASIKMALAYA, 07-01-1938 MARIBAYA, 07/08/2021 LILIS LISMAYANI 3206206705800001 LILIS (082320332729)
19 3206204107380104 SUMIRAH TASIKMALAYA, 08-20-1950 PANAEKAN, 16/08/2021 ADE SUDARYAT 3206200508640004 ADE S(085314674950)
20 3206206008500001 LILIS MARYANI DENPASAR, 06-24-1965 ANCOL, 05/08/2021 NANDANG S 3206201408590001 NANDANG (082247549241)
21 ALESHA PUTRI R CIAMIS, 04-08-2021 PANAEKAN YOGA RAHAYU 3206202007900002 YOGA (082315859446)
22 3206204808620003 ROKAYAH CIAMIS, 08-08-1962 PANAEKAN, 19/08/2021 ADE SUDARYAT 3206200508640004 ADE S(085314674950)
23 3206204509400002 MUTIAH TASIKMALAYA, 03-09-1940 ANCOL, 19/08/2021 ENGKOS 3206200609690003 ENGKOS (081224275259)
24 3206205207570002 NINING TASIKMALAYA, 07-12-1937 MARIBAYA, 27/08/2021 JUMIATI, SH 3206204101830009 JUMIATI (085321000314)
25 3206204508520001 OJEH TASIKMALAYA, 08-05-1952 PANAEKAN, 29/08/2021 RIFKI ARIPATULOH 3206200107930056 RIFKI (085220896679)
26 3206200206570005 SAPRI SUPRIATNA TASIKMALAYA, 02-06-1957 ANCOL, 25/09/2021 ENGKOS 3206200609690003 ENGKOS (081224275259)
27 3206205507470001 DASIH TASIKMALAYA, 15-07-1957 PANAEKAN, 26/09/2021 DEDE YENI ANGGRAENI 3206206010800003 DEDE YENI (087764963884)
28 3206204107320007 LOMRAH TASIKMALAYA, 01/07/1932 MARIBAYA, 21/09/2021 ENENG NURHAYATI 3206204807670001 ENENG (082118241146)
29 '3206204107480131 ONOK TASIKMALAYA, 01/07/1948 PANAEKAN, 22/10/2021 CUCU SUPRIATNA 3206202812810002 CUCU (082116031846)
30 3206205602590002 IKAH SRIHARTIKA, S.Pd CIAMIS, 16/02/1959 PANAEKAN, 28/10/2021 CUCU SUPRIATNA 3206202812810002 CUCU (082116031846)
31 3204334107920200 IMAS NURHAYATI BANDUNG, 01/07/1992 ANCOL, 08/10/2021 YANA 3206201007690001 YANA (082318430011)
32 3206204203580001 IRAH TASIKMALAYA, 02/03/1958 ANCOL, 09/11/2021 YANA 3206201007690001 YANA (082318430011)
33 3206204711570001 YAYAH KHOERIYAH TASIKMALAYA, 02/05/1961 MARIBAYA, 05/11/2021 ENENG NURHAYATI 3206204807670001 ENENG (082118241146)
34 3206200107360101 MAHPUDIN TASIKMALAYA, 01/07/1935 MARIBAYA, 20/12/2021 ISKANDAR 3206200207550001 ISKANDAR (082119372591)
35 3206205505640002 ENUNG ANAH TASIKMALAYA, 15/05/1964 MARIBAYA,06/01/2022 IKA KURNIASIH 3206206712810001 IKA (085215490215)
36 3206201301420001 UKIN, A.MA.PD TASIKMALAYA, 13/01/1942 ANCOL, 06/01/2022 SUSI SUANTI 3206205006890003 SUSI (085223587021)
37 3206206703420002 RUKASIH TASIKMALAYA, 27/03/1942 PANAEKAN, 03/01/2022 YAYAT 3206200301780001 YAYAT (085792920733)
38 3206200107420133 ABAS TASIKMALAYA, 01/07/1942 MARIBAYA, 28/01/2022 IRWAN KUSWANA 3278062005840005 IRWAN (082126814100)
39 3206204107400386 MIOH TASIKMALAYA, 01/07/1940 PANAEKAN, 01/03/2022 RIFKI ARIPATULOH 3206200107930056 RIFKI (085220896679)
40 3206206906120001 ALYA SA'BANFITRIANI TASIKMALAYA, 29/06/2012 ANCOL, 03/03/2022 TOTO SURIPTO 3205201707850007 TOTO (082317193558)
41 3215131408620001 AGUS SUHADI BANDUNG, 14/08/1962 MARIBAYA, 04/03/2022 KOMAR SB 3206200507550015 KOMAR (082310778856)
42 3206202505460001 OMAN TASIKMALAYA, 25/05/1946 PANAEKAN, 05/03/2022 CUCU SUPRIATNA 3206202812810002 CUCU (082116031846)
43 3206201112500001 NUKRO TASIKMALAYA, 11/12/1950 PANAEKAN, 10/04/2022 YAYAT 3206200301780001 YAYAT (085792920733)
44 3206205211300001 ROHANAH TASIKMALAYA, 12/11/1930 ANCOL, 16/04/2022 NANDANG S 3206201408590001 NANDANG (082247549241)
45 3206206812490002 MUMUN MAEMUNAH TASIKMALAYA, 28/12/1949 MARIBAYA, APRIL 2022 NANA SUMARNA 3206201001790002 NANA S(085221423484)
46 3206204107470114 RUKMINI TASIKMALAYA, 01/07/1947 ANCOL, 18/04/2022 ENGKOS 3206200609690003 ENGKOS (081224275259)
47 3206200306540002 MAKIN TASIKMALAYA, 03/06/1954 PANAEKAN, 08/05/2022 DEDE YENI ANGGRAENI 3206206010800003 DEDE YENI (087764963884)
48 3206201403560003 HERMAN TASIKMALAYA, 14/03/1956 PANAEKAN, 27/06/2022 DEDE YENI ANGGRAENI 3206206010800003 DEDE YENI (087764963884)
49 3206204507520007 RUHYATI TASIKMALAYA, 05/07/1952 PANAEKAN, 15/06/2022 ENDING 3206201604420001 NOVI (081224274275)
50 3206200102520002 EMAN TASIKMALAYA, 01/02/1952 MARIBAYA, 02/06/2022 NANA KUSMANA 3206201005790004 NANA K (085323392678)
51 3206205005530002 UUN NURJANAH TASIKMALAYA, 10/05/1953 MARIBAYA, 25/08/2022 DANA KAMALUDIN 3206201604870002 DANA (085283562518)
52 3206204311550003 KUSNATI TASIKMALAYA, '03/11/1955 ANCOL, 29/08/2022 YANA 3206201007690001 YANA (082318430011)
53 3206204107660182 MARNI SUMARNI TASIKMALAYA, 01/07/1966 MARIBAYA, 30/08/2022 NANA SUMARNA 3206201001790002 NANA S(085221423484)
54 3206204201650003 HADYATI TASIKMALAYA, 02/01/1965 PANAEKAN DEDE YENI ANGGRAENI 3206206010800003 DEDE YENI (087764963884)
55 3206206002340001 JAOJAH TASIKMALAYA, 20/02/1934 PANAEKAN, JANUARI 2022 ADE SUDARYAT 3206200508640004 ADE S(085314674950)
56 3206200506680002 LILI SUMARNA TASIKMALAYA, 05/06/1968 PANAEKAN, 29/09/2022 NOVI KAGARTIKA, S.Pd 3206205711860001 NOVI (081224274275)
57 3206201509350002 SAMSU TASIKMALAYA, 15/09/1935 ANCOL, 30/09/2022 YANA 3206201007690001 YANA (082318430011)

Ancol, 22 Oktober 2022

Kepala Desa

AGUS RAHMAT
 FORMULIR BUKU POKOK PEMAKAMAN

Nama Tempat Pemakaman : ………………………………………

Alamat : ………………………………………
NO NIK NAMA LENGKAP TEMPAT DAN TANGGAL MENINGGAL

1 2 3 4
FORMULIR BUKU POKOK PEMAKAMAN

NAMA DAN NO. HP KELUARGA

TANGGAL PEMAKAMAN NAMA PELAPOR NIK PELAPOR KET
YANG DAPAT DIHUBUNGI
5 6 7 8 9

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Petugas Pemakaman

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