Anda di halaman 1dari 2

KEMENTERIAN AGAMA

KANTOR URUSAN AGAMA KECAMATAN BLEGA


Jl. Raya Blega 18 Telp. ( 031 ) 3041866 Kode Pos 69174
K A B U P A T E N B A N G K AL A N

Nomor : Kk. ...............................................................................................

Kepada

Yth. ...............................................................................................

...............................................................................................
KEMENTERIAN AGAMA
KANTOR URUSAN AGAMA KECAMATAN BLEGA
Jl. Raya Blega 18 Telp. ( 031 ) 3041866 Kode Pos 69174
K A B U P A T E N B A N G K AL A N

Di .....................................................................................

Anda mungkin juga menyukai