FORMULIR PENDAFTARAN PARSADAAN
MUNTHE/DALIMUNTHE LABUHANBATU
NAMA : ............................................................
TEMPAT/TANGGAL LAHIR : ............................................................
PEKERJAAN : ............................................................
ALAMAT : ............................................................
NO HP
:
............................................................
ORANG TUA :
NAMA : ................................... ASAL : ..................................
KAKEK :
NAMA : ................................... ASAL : ..................................
UYUT :
NAMA : ................................... ASAL : ..................................
ANGGOTA KELUARGA :
|
NO.
|
NAMA
|
UMUR
|
KETERANGAN
|
|
1
|
|
|
ISTRI
|
|
2
|
|
|
ANAK
KANDUNG
|
|
3
|
|
|
|
|
4
|
|
|
|
|
5
|
|
|
|
|
6
|
|
|
|
|
7
|
|
|
|
|
8
|
|
|
|
RANTAUPRAPAT,...........................................
(...................................................)
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