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DUPLIKAT KUTIPAN AKTA NIKAIH DUPLICATE EXCERPT OF MERRIAGE CERTIFICATE Nomor /Nember : 47/47/1V/1991 Praca Hari / Om the day Seale Tanggal, Bolan, Tahon 15 April 1991 uM Date, Month Year Bertepotaa (Or + 2S Romadion 1411 n Pabel (47 ns Tetah dilangwunghan akad nikah soorang laki-taki There has been cnthenticuted a covenant of marriage of a mam 01, Nama / Fadl Name SUMIRAN @2. Bin /Son of PASIMIN @3, TTL? / Place and date of birth Toban, 13-43-1909 04, NIK* / Persomal kdentity Number 05. Kewarganegarnaa / Nationality 06. Agama | Relogion 07. Pekerjaan / Occupution 08. Alamat tempot thaggal / Adibess Dengan sora wasita (40 9 wom” NGATUNI _ BIO * ©). TTL/ Place ont dete of rth : Taban, 30-01-1968 07, Pekerjaan / Oc ——— - G8 Alamat tempat tinggal | Address Da Sembcragene Kec. Mompanc Denyoa wali sila / wich wedklons guordhon 01. Nama / Fil! Name : BISO 2. TTL/ Place om dose of birch + Teben, $0 Tebos 0 cs 2 Indowesie Ob Agama / Reign ‘Yaam = 05. Pekerjaan / Occopution > Tani 06. Alamat tompot tinesa! | Address : Semberageag ‘Scbagal wali masab / hakion.*) ax masod / jude guardian :*) ‘Dengan mas hawin berupa / with the chowry in term of Uneg Rp. 10.000,- Tonal / betang:*) Cash /indedied *). Sctelah shad nikah, sami membaca dan menandatangi Sighst TaTiq (Ya / Thdakey / Aher the comvenant of marriage, Imaband wo real and sign Sigh Taller Tebas, 06-62-2015 M. si sews domgan Abts Nika bsteri nen ee aera — | 4 0 feos — fommeien 5d Dierks La a 2 Core se SO pas Dees oreo >) * NIK (Nomor lode orm (Tengu aun Tego Une) NIP, 19600709199103 1001 Il dnptibat ind Gitenertan pode KMA Nemor 7S Tahun 2014/ Contents of this depiicate ts based om EMA No. 75 of 2016