CIVIL REGISTRY
(INDONESIAN NATIONALITY)
EXCERPT OF BIRTH CERTIFICATE
No. 484_1/1774-Cs/1990
Based on ————————————GENERAL———————————birth register by virtue of
State Gazette —————————1920————————— in –Tangerang–it was recorded that
in ——————–Tangerang————————————————- on date the twenty eighth day
of March, at 20.35 WIB ——————————————in the year nineteen
———————————–ninety——————————— was born:
————————————————Andita Frista———————————————–
————————————————JHON———————————————–
And
————————————————–PATRICIA————————————————-
This extract is in accordance with the current conditions.
Tangerang., on date the third day of May
In the year nineteen ninety
Head of the Registry Office
Drs. H. ASEP KADARMAN
———————————–
NIP. 010 062 075