BANTEN PROVINCE
REGENCY OF TANGERANG
ID Number : 330xxxxxxxxxxxxxxxxxxxx
Name : AYU ENDAH PERTIWI
Place/ Date of Birth: xxxxx
Gender : FEMALE Blood Type: O
Address : xxxxx
RT/RW: xxxxx
Village: xxxxx
District: xxxxx
Religion : ISLAM
Marital Status : SINGLE
Occupation : STUDENT
Nationality : INDONESIAN
Valid until : LIFETIME
BIRTH CERTIFICATE
CSL
CIVIL REGISTRATION
(INDONESIAN CITIZEN)
EXCERPT OF
BIRTH CERTIFICATE
No. 3836/TP/2000
From
the................................................GENERAL...............................................registry
of births according to State Gazzette 1920 No. 751 Jo. 1927 No. 564 in Boyolali
Civil Registration Office states that in.............................................Boyolali...........................................................
On
the fifteen of April nineteen ninty seven was born:
---------------------------------------:AYU
ENDAH PERTIWI:----------------------------------------
a
daughter from the husband and wife : Slamet Riyanto with Sri Amini.
-------------------------
This excerpt is in accord to the condition this
day.
Boyolali.................dated on the third of
August
two
thousands.--------------------------------------
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