` GBKP RUNGGUN LAU CIH Jl Jamin Ginting Kedai Kopi Tarigan Kel Sidomulyo

(Depan Simpang Gardu)

SEKTOR 4

PENDATAAN ULANG JEMAAT

1. Keluarga Penggelaren : ____________________________________________________

2. Alamat : ____________________________________________________
: ____________________________________________________
3. Gelar Bapa : ____________________________________________________
Tempat/Tanggal Lahir : ____________________________________________________
No HP/Wa : ____________________________________________________

4. Gelar Nande : ____________________________________________________

Tempat/Tanggal Lahir : ____________________________________________________
No HP/Wa : ____________________________________________________

5. Gelar anak
1. Gelar : ______________________________________________
Tempat/Tanggal Lahir : ______________________________________________
No HP/Wa : ______________________________________________
2. Gelar : ______________________________________________
Tempat/Tanggal Lahir : ______________________________________________
No HP/Wa : ______________________________________________
3. Gelar : ______________________________________________
Tempat/Tanggal Lahir : ______________________________________________
No HP/Wa : ______________________________________________
4. Gelar : ______________________________________________
Tempat/Tanggal Lahir : ______________________________________________
No HP/Wa : ______________________________________________
5. Gelar : ______________________________________________
Tempat/Tanggal Lahir : ______________________________________________
No HP/Wa : ______________________________________________