SURAT KETERANGAN MANDAH ALPEN SITUMORANG



SURAT-KETERANGAN MANDAH
Nomor : 06 / 12.01.05.2006 / S-Ket / 2014

Yang bertanda tangan dibawah ini Kepala Desa Manduamas Lama Kecamatan Manduamas Kabupaten Tapanuli Tengah, menerangkan bahwa :
Nama Lengkap                  :               ALPEN SITUMORANG
Jenis Kelamin                     :               Laki-laki.
Tempat tanggal lahir       :               Sikoling-koling, 21 – Januari 1995
Agama                                  :               Kristen
Status perkawinan          :               Belum Kawin.
Pendidikan                         :               SMA.
Pekerjaan                           :               -
No. KK                                  :               1201052101950004
No. NIK                                :               1201052610070010
Alamat                                  :               Dusun VI Sikoling-koling, Desa Manduamas Lama Kecamatan                                                                              Manduamas Kabupaten Tapanuli Tengah Provinsi Sumatera                                                                                        Utara Kode Pos : 22565
                Surat keterangan ini diperbuat dan di berikan kepadanya menurut permintaannya sendiri sehubungan dengan maksudnya hendak Mandah :
                Ke                                           :               Kapling Abadi Jaya
                Kelurahan                           :               Sagulung
                Kecamatan                         :               Sagulung
                Kabupaten / Kota            :               Kota Batam
                Provinsi                                :               -
Demikian surat keterangan ini diperbuat dan diberikan kepadanya, untuk dapat dipergunakan seperlunya.
                                                                                                                          Manduamas Lama, 09 Januari 2014
                                                                                                                                Kepala Desa Manduamas Lama,
            
                                                                                                                                Patarsono Tinambunan, S.Pi

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