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RUKUN TETANGGA 003


RUKUN WARGA 01
KELURAHAN JATI PADANG

KECAMATAN PASAR MINGGU JAKARTA SELATAN

SURAT PENGANTAR
NOMOR : ………………...........................
Yang bertanda tangan di bawah ini Ketua RT. 003 RW. 01 Kelurahan Jati Padang
Kecamatan Pasar Minggu menerangkan :
Nama : ........................................................................................
Tempat/Tgl. Lahir : ........................................................................................
Jenis Kelamin : ........................................................................................
Agama : ........................................................................................
NIK / No. KTP : ........................................................................................
Alamat : ........................................................................................
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Maksud / Tujuan : ........................................................................................
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Jakarta, ………………… 20….
KETUA RT. 003/01
Nomor : .........................................
Tanggal : .........................................
KETUA RW. 01

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