K 3215.

0147640
KARTU KELUARGA
No. 3215031308120011
Nama Kepala Keluarga : TAMIN
Kecamatan : TELUKJAMBE TIMUR
Alamat : PRM, BINTANG ALAM Kabupaten/kota : KARAWANG
RT/RW : 034/011 Kode Pos : -
Desa/Kelurahan : TELUKJAMBE Provinsi : JAWA BARAT

Jenis Tempat Lahir Tanggal

No. Nama Lengkap NIK Agama Pendidikan Jenis Pekerjaan
Kelamin Lahir
......................................................................................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................................................................................
(1) (2) (3) (4) (5) (6) (7) (8)
......................................................................................................................................................................................................................................................................................................................................................................................
1 TAMN 3215030101720002 LAKI-LAKI BOGOR 01-02-1972 ISLAM SLTA/SEDERAJAT KARYAWAN SWASTA
2 SRI ROMANI 3215037107720002 PEREMPUAN KLATEN 01-07-1972 ISLAM SLTA/SEDERAJAT MENGURUS RUMAH TANGGA
3 RAFIDA ARINI 3215034205990006 PEREMPUAN KARAWANG 02-05-1999 ISLAM SLTA/SEDERAJAT PELAJAR/MAHASISWA
4 FARHAN RAHMAD RAMADHAN 3215035207010007 LAKI-LAKI KARAWANG 12-07-2001 ISLAM TAMAT SD/SEDERAJAT PELAJAR/MAHASISWA
5 - - - - - - - -
6 - - - - - - - -
7 - - - - - - - -
8 - - - - - - - -
9 - - - - - - - -
10 - - - - - - -
-
Status Status Hubungan Dokumen Imigrasi Nama Orang Tua
No. Kewarganegaraan
Perkawinan Dalam Keluarga No. Paspor No. KITAS/KITAP Ayah Ibu
......................................................................................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................................................................................
(9) ( 10 ) ( 11 ) ( 12 ) ( 13 ) ( 14 ) ( 15 )
......................................................................................................................................................................................................................................................................................................................................................................................
1 KAWIN KEPALA KELUARGA WNI - - KEDIL ANAH
2 KAWIN ISTRI WNI - - ABDUL LATIF EBOT
3 BELUM KAWIN ANAK WNI - - TAMIN SRI ROMANI
4 BELUM KAWIN ANAK WNI - - TAMIN SRI ROMANI
5 - - - - - - -
6 - - - - - - -
7 - - - - - - -
8 - - - - - - -
9 - - - - - - -
10 - - - - - - -
TAH K
E RIN A

BU
Dikeluarkan Tanggal : 13-08-2012

PE
DINAS KEPALA DINAS KEPENDUDUKAN DAN

PATEN
K
LEMBAR : I. Kepala Keluarga KEPALA KELUARGA DAN PE EPENDUDUKA PENCATATAN SIPIL
NCATA
II. RT TAN SIP N
IL
III. Desa/Kelurahan
IV. Kecamatan
TAMIN H. EKA SANATHA,SH.MM
Tanda Tangan/Cap Jempol NIP.19720612 199603 1004
 K 32130886001
KARTU KELUARGA
No.3213050809140010
Nama Kepala Keluarga : CECEP SUPRIADI
Desa/Kelurahan : CUHAMBULU
Alamat : KP. BAKAN KUTA Kecamatan : PABUARAN
RT/RW : 013/003 Kabupaten/Kota : SUBANG
Kode Pos : 41262 Provinsi : JAWA BARAT

Jenis Tempat Lahir Tanggal

No. Nama Lengkap NIK Agama Pendidikan Jenis Pekerjaan
Kelamin Lahir
......................................................................................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................................................................................
(1) (2) (3) (4) (5) (6) (7) (8)
......................................................................................................................................................................................................................................................................................................................................................................................
1 CECEP SUPRIADI 3213053005920001 LAKI-LAKI SUBANG 30-05-1992 ISLAM SLTA/SEDERAJAT KARYAWAN SWASTA
2 HENI KARNAEN 3213056108950001 PEREMPUAN SUBANG 21-06-1995 ISLAM SLTP/SEDERAJAT MENGURUS RUMAH TANGGA
3 ABHIZAR AL GHIFARI 3213051912140001 LAKI-LAKI SUBANG 19-12-2014 ISLAM TDK/BLM SEKOLAH BELUM/TIDAK BEKERJA
4 - - - - - - - -
5 - - - - - - - -
6 - - - - - - - -
7 - - - - - - - -
8 - - - - - - - -
9 - - - - - - - -
10 - - - - - - - -

Status Status Hubungan Dokumen Imigrasi Nama Orang Tua

No. Kewarganegaraan
Perkawinan Dalam Keluarga No. Paspor No. KITAS/KITAP Ayah Ibu
......................................................................................................................................................................................................................................................................................................................................................................................
......................................................................................................................................................................................................................................................................................................................................................................................
(9) ( 10 ) ( 11 ) ( 12 ) ( 13 ) ( 14 ) ( 15 )
......................................................................................................................................................................................................................................................................................................................................................................................
1 KAWIN KEPALA KELUARGA WNI - - TADIM JUBAEDAH
2 KAWIN ISTRI WNI - - HASAN BASRI KARYATI
3 BELUM KAWIN ANAK WNI - - CECEP SUPRIADI HENI KARNAEN
4 - - - - - - -
5 - - - - - - -
6 - - - - - - -
7 - - - - - - -
8 - - - - - - -
9 - - - - - -
10 - - -

Dikeluarkan Tanggal : 16-04-2018

KEPALA DINAS KEPENDUDUKAN DAN
LEMBAR : I. Kepala Keluarga KEPALA KELUARGA
PENCATATAN SIPIL
II. RT DINAS KEPENDUDUKAN
DAN PENCATATAN SIPIL
III. Desa/Kelurahan
IV. Kecamatan
CECEP SUPRIADI DADANG KURNIANUDIN, S.IR
Tanda Tangan/Cap Jempol NIP.1967070919977031005