CIVIL
REGISTRATION
JAKARTA
EXCERPT
BIRTH
CERTIFICATE
No.
196/1991
From GENERAL
registration for Indonesian Citizen births pursuant to the State
Gazette in Jakarta, that in Jakarta om date twenty one of December
nine teen and ninety one was born :
…........................................................................... : REVI
WULANDARI :
…........................................................................ son
of married couple : ….......... SUPARMIN dan YANTI
MALA....................
This
excerpt conforms yo the condition on this day Jakarta,
dated
first of January.......
nine
teen and ninety one,
Head of
Civil Registration Office
KIKI
PURNAMASARI
NIP : …...........................
