KAMPUNG :

RW/RT :
DESA :
KECAMATAN :

SURAT KETERANGAN TENTANG PERKAWINAN

Ketua RT..... Kp. Cisaat RW.......... Desa Sabandar Kecamatan Karangtengah Kabupaten Cianjur,
dengan ini menerangkan berdasarkan sepengetahuan Kami :

Nama : ..............................................................................................................................
.
Tempat,Tgl,Lahir :
...............................................................................................................................
Agama : ..............................................................................................................................
.
Status : ..............................................................................................................................
.
Pekerjaan : ..............................................................................................................................
.
Alamat : ..............................................................................................................................
.

Betul telah menikah di Kp. Cisaat RT......... RW.......... Desa Sabandar Kecamatan Karangtengah
Kabupaten Cianjur, Pada Tanggal ..... Bulan ................. Tahun 2020, Dengan Mas Kawin ....... Gram
Emas, dan di saksisakan oleh saksi serta turut menandatangani, dengan:

Nama : ..............................................................................................................................
.
Tempat,Tgl,Lahir :
...............................................................................................................................
Agama : ..............................................................................................................................
.
Status : ..............................................................................................................................
.
Pekerjaan : ..............................................................................................................................
.
Alamat : ..............................................................................................................................
.

Dan sebagai Wali adalah :

Nama : ..............................................................................................................................
.
Tempat,Tgl,Lahir :
...............................................................................................................................
Alamat : ..............................................................................................................................
.

Saksi-Saksi
1. ........................ ...................................
2. ........................ ...................................
3. ........................ ...................................
4. ........................ ...................................

Demikian Surat Keterangan ini dibuat untuk dipergunakan melengkapi persyaratan administrasi.

Dicatat dalam buku register kami

Nomor : …….. /…./ Um
Tanggal, .........................
KETUA RT

......................................