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  • Suket Kematian 99913515

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    pemdes candigugur
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    A death certificate was issued for Khairon, a 52-year-old Muslim man from Dk klawen RT 07 RW03 who passed away on December 26, 2022 at 4:25 AM at his home from an illness. The certificate was based on a report from his wife, 47-year-old Juariyah, a farmer who lives at the same address in Candigugur Village, Bawang Subdistrict.

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    SUKET-KEMATIAN-99913515

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    A death certificate was issued for Khairon, a 52-year-old Muslim man from Dk klawen RT 07 RW03 who passed away on December 26, 2022 at 4:25 AM at his home from an illness. The certificate was based on a report from his wife, 47-year-old Juariyah, a farmer who lives at the same address in Candigugur Village, Bawang Subdistrict.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    6 views1 page

    Suket Kematian 99913515

    Uploaded by

    pemdes candigugur
    A death certificate was issued for Khairon, a 52-year-old Muslim man from Dk klawen RT 07 RW03 who passed away on December 26, 2022 at 4:25 AM at his home from an illness. The certificate was based on a report from his wife, 47-year-old Juariyah, a farmer who lives at the same address in Candigugur Village, Bawang Subdistrict.

    Copyright:

    © All Rights Reserved
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    Pemerintah Kabupaten : BATANG

    Kecamatan : BAWANG
    Desa/Kelurahan : CANDIGUGUR

    UNTUK YANG BERSANGKUTAN


    SURAT KETERANGAN KEMATIAN
    Nomor: 172/SUKET/0123/2023

    Yang bertanda tangan dibawah ini, menerangkan bahwa:


    Nama Lengkap : KHAERON
    Jenis Kelamin : Laki-laki
    Tgl. Lahir/Umur : 04 April 1970 / 52 Tahun
    Agama : Islam
    Alamat : Dk klawen RT 07 RW03

    Telah Meninggal Dunia pada:


    Hari : Senin
    Tanggal : 26 Desember 2022
    Pukul : 04:25 WIB
    Bertempat di : Rumah
    Penyebab Kematian : Sakit

    Surat Keterangan ini dibuat berdasarkan keterangan pelapor:


    Nama Lengkap : JUARIYAH
    NIK : 3325054312750002
    Tgl. Lahir/Umur : 03 Desember 1975 / 47 Tahun
    Pekerjaan : PETANI/PEKEBUN
    Alamat : Dk klawen RT07 RW03 Ds.Candigugur Kec.Bawang

    Hubungan pelapor dengan yang meninggal: ISTRI

    Batang, 19 Januari 2023


    Kepala Desa Candigugur

    MUZAMIL NM

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