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    KARTU KB KARTU KB

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    Tgl Kembali ! Keterangan Tgl Kembali ! Keterangan

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    KARTU KB KARTU KB
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    Nama akseptor : Nama akseptor :
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    Alamat : Alamat :
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    Nama suami : Nama suami :
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    Tgl Kembali ! Keterangan Tgl Kembali ! Keterangan

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