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Download Kartu Keluarga PDF Form
Dusun/Dukuh/Kampung
:
RT
RW
Jumlah Anggota Keluarga
orang
DATA KELUARGA
No.
Nama Lengkap
Nomor KTP/Nopen
Alamat Sebelumnya
Nomor Paspor
1
1
2
3
4
5
6
7
8
9
10
2
3
4
5
No. Jenis Kelamin
Tempat Lahir
7
Tanggal/Bulan/Tahun
Lahir
9
8
Umur
10
Akte Lahir/
Surat Lahir
11
Nomor Akta Kelahiran/
Surat Kenal Lahir
12
Golongan
Darah
13
Agama/
Status
Kepercayaan
Perkawinan
14
15
Akta Perkwn/
Buku Nikah*)
16
Nomor Akta Perkawinan/
Buku Nikah*)
17
Tanggal Berakhir...
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