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ei 2019
13 M
UNTUK YANG
BERSANGKUTAN
SURAT KEMATIAN
No 474.3 / / SK / III / 2018
Yang bertanda Tangan dibawah ini, Menerangkan
Bahwa
Nama : EKA LIESTA SUWARNO
Jenis Kelamin : Perempuan
Usia : 36 Tahun ( Pada Saat Meninggal)
Pekerjaan : Wiraswasta
Alamat : Tunon RT. 005/001 Desa Tunon
Tegal Jawa Tengah
Telah Meninggal dunia Pada :
Hari : Minggu
Tanggal : 18 Februari 2018
Di : Rumah
Disebebkan karena :
SAKIT
Surat Keterangan ini dibuat atas dasar yang sebenarnya
Nama Yang Melapor : Afrizal Saputra
Hub. dengan yang meninggal : Suami
Tunan, 06 Maret 2018
a.n. Lurah Tunan
Drs. YUSUF EFENDI
Nip : 1960190514000015
UNTUK YANG
BERSANGKUTAN
SURAT KEMATIAN
No 474.3 / / SK / X / 2013
Yang bertanda Tangan dibawah ini, Menerangkan
Bahwa :
Nama : NURIYAH
Jenis Kelamin : Perempuan
Usia : 41 Tahun ( Pada Saat Meninggal)
Pekerjaan : Mengurus Rumah Tangga
Alamat : Cikaret RT. 004 RW.009
Kel. Harapanjaya Kec. Cibinong
Kab. Bogor
Telah Meninggal dunia Pada :
Hari : Sabtu
Tanggal : 06 Oktober 2013
Di : Rumah Sakit
Disebebkan karena :
SAKIT
Surat Keterangan ini dibuat atas dasar yang sebenarnya
Nama Yang Melapor : Tiara Ningsih
Hub. dengan yang meninggal : Anak
Cibinong, 15 Oktober 2013
a.n. Lurah Harapanjaya
ASEP SOBARI AHMAD
SURAT KEMATIAN
No 474.3 / / SK / XII /2020
Yang bertanda Tangan dibawah ini, Menerangkan
Bahwa :
Nama : DEDEN KURNIADI
Jenis Kelamin : Laki-laki
Usia : 41 Tahun ( Pada Saat Meninggal)
Pekerjaan : Wiraswasta
Alamat : Jl Ciapus no.14 kp cimanglid RT 002
RW 012 Kelurahan Sirnagalih
Kecamatan Tamansari Kabupaten
Bogor
Telah Meninggal dunia Pada :
Hari : Senin
Tanggal : 21 Desember 2020
Di : Rumah
Disebebkan karena :
SAKIT
Surat Keterangan ini dibuat atas dasar yang sebenarnya
Sirnagalih, 21 Desember 2020
a.n. Lurah Sirnagalih
AHMAD
UNTUK YANG
BERSANGKUTAN

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sirn3.docx

  • 1. ei 2019 13 M UNTUK YANG BERSANGKUTAN SURAT KEMATIAN No 474.3 / / SK / III / 2018 Yang bertanda Tangan dibawah ini, Menerangkan Bahwa Nama : EKA LIESTA SUWARNO Jenis Kelamin : Perempuan Usia : 36 Tahun ( Pada Saat Meninggal) Pekerjaan : Wiraswasta Alamat : Tunon RT. 005/001 Desa Tunon Tegal Jawa Tengah Telah Meninggal dunia Pada : Hari : Minggu Tanggal : 18 Februari 2018 Di : Rumah Disebebkan karena : SAKIT Surat Keterangan ini dibuat atas dasar yang sebenarnya Nama Yang Melapor : Afrizal Saputra Hub. dengan yang meninggal : Suami Tunan, 06 Maret 2018 a.n. Lurah Tunan Drs. YUSUF EFENDI Nip : 1960190514000015 UNTUK YANG BERSANGKUTAN SURAT KEMATIAN No 474.3 / / SK / X / 2013 Yang bertanda Tangan dibawah ini, Menerangkan Bahwa : Nama : NURIYAH Jenis Kelamin : Perempuan Usia : 41 Tahun ( Pada Saat Meninggal) Pekerjaan : Mengurus Rumah Tangga Alamat : Cikaret RT. 004 RW.009 Kel. Harapanjaya Kec. Cibinong Kab. Bogor Telah Meninggal dunia Pada : Hari : Sabtu Tanggal : 06 Oktober 2013 Di : Rumah Sakit Disebebkan karena : SAKIT Surat Keterangan ini dibuat atas dasar yang sebenarnya Nama Yang Melapor : Tiara Ningsih Hub. dengan yang meninggal : Anak Cibinong, 15 Oktober 2013 a.n. Lurah Harapanjaya ASEP SOBARI AHMAD SURAT KEMATIAN No 474.3 / / SK / XII /2020 Yang bertanda Tangan dibawah ini, Menerangkan Bahwa : Nama : DEDEN KURNIADI Jenis Kelamin : Laki-laki Usia : 41 Tahun ( Pada Saat Meninggal) Pekerjaan : Wiraswasta Alamat : Jl Ciapus no.14 kp cimanglid RT 002 RW 012 Kelurahan Sirnagalih Kecamatan Tamansari Kabupaten Bogor Telah Meninggal dunia Pada : Hari : Senin Tanggal : 21 Desember 2020 Di : Rumah Disebebkan karena : SAKIT Surat Keterangan ini dibuat atas dasar yang sebenarnya Sirnagalih, 21 Desember 2020 a.n. Lurah Sirnagalih AHMAD UNTUK YANG BERSANGKUTAN