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    Deat Certificate

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    jonik_nik
    This death certificate documents the death of H. Yasir, a 64-year-old male from Tanjung Bumi, Bangkalan, Madura, Indonesia. According to the information provided by his relative Taufik Hidayah, a 24-year-old seaman, Yasir died on March 26th, 2009 in Tanjung Bumi due to an unspecified illness. The village head of Tanjung Bumi, H. Mardju'i, declares this death certificate to be accurate based on the information from Yasir's relative.

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    Deat Certificate

    Uploaded by

    jonik_nik
    16 views1 page
    This death certificate documents the death of H. Yasir, a 64-year-old male from Tanjung Bumi, Bangkalan, Madura, Indonesia. According to the information provided by his relative Taufik Hidayah, a 24-year-old seaman, Yasir died on March 26th, 2009 in Tanjung Bumi due to an unspecified illness. The village head of Tanjung Bumi, H. Mardju'i, declares this death certificate to be accurate based on the information from Yasir's relative.

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    This death certificate documents the death of H. Yasir, a 64-year-old male from Tanjung Bumi, Bangkalan, Madura, Indonesia. According to the information provided by his relative Taufik Hidayah, a 24-year-old seaman, Yasir died on March 26th, 2009 in Tanjung Bumi due to an unspecified illness. The village head of Tanjung Bumi, H. Mardju'i, declares this death certificate to be accurate based on the information from Yasir's relative.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as doc, pdf, or txt
    16 views1 page

    Deat Certificate

    Uploaded by

    jonik_nik
    This death certificate documents the death of H. Yasir, a 64-year-old male from Tanjung Bumi, Bangkalan, Madura, Indonesia. According to the information provided by his relative Taufik Hidayah, a 24-year-old seaman, Yasir died on March 26th, 2009 in Tanjung Bumi due to an unspecified illness. The village head of Tanjung Bumi, H. Mardju'i, declares this death certificate to be accurate based on the information from Yasir's relative.

    Copyright:

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    Download as DOC, PDF, TXT or read online from Scribd
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    of 1

    Code : C-3.

    26
    Regency/Municipal Fovernment : Bangkalan – East Java
    Subdistric : Tanjung Bumi
    Village : Dsn Tanjung – Tanjung Bumi
    Bangkalan - Madura

    FOR THE PERSON INVOLVED


    DEATH CERTIFICATE
    No. 591.4/16/VI/2009

    The Undersigned declares that

    Complete Name : H. YASIR


    Sex : Male
    Age : 64 years old
    Address : Dsn. Tanjung – Tanjung Bumi
    Bangkalan – Madura

    Died on

    Day : Thuesday
    Date : March, 26th 2009
    Stay in : Dsn Tanjung Subdistric at Tanjung Bumi Regency
    Bangkalan
    Underlying course : Sick

    The Death Sertificate is sincerelly made in the base of information from :

    Complete Name : Taufik Hidayah


    Crew ID : 420202
    Age : 24 years old
    Accupation : Seaman
    Familial Relation : Parents

    Bangkalan, April 03th 2009


    Head of Vilage

    H. MARDJU'I

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