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Buku Catatan Kehendak

Nikah

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Lampiran 25 PMA No. 2 Tahun 1990

- Pasal 4 ayat (2) –

Model N10

BUKU CATATAN KEHENDAK NIKAH

Nama, Umur, Warga Negara, Pekerjaan, Tempat Tinggal
Calon Suami Calon Istri Tanda tangan
No- (terangkan jejaka, duda (terangkan perawan, atau Wali a. Kepala Desa/ Tanggal Nomor Tanda
Tanggal Biaya
mor atau beristri) janda) (terangkan status dan hu- Kelurahan akad nikah Tanggal Tangan Keterangan
Laporan pencatatan
Urut Bila duda atau janda jelaskan bungannya dengan calon b. Pembantu dilangsungkan akta nikah PPN
a. Akta cerai/kutipan buku pendaftaran talak/cerai istri) PPn
b. Surat keterangan matinya suami/istri
1 2 3 4 5 6 7 8 9 10 11

Catatan : kolom 7 s/d 10 diisi oleh PPN

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Lampiran 25 PMA No. 2 Tahun 1990

- Pasal 4 ayat (2) –

You're Reading a Preview

Model N10

BUKU CATATAN KEHENDAK NIKAH

Nama, Umur, Warga Negara, Pekerjaan, Tempat Tinggal
Calon Suami Calon Istri Tanda tangan
No- (terangkan jejaka, duda (terangkan perawan, atau Wali c. Kepala Desa/ Tanggal Nomor Tanda
Tanggal Biaya
mor atau beristri) janda) (terangkan status dan hu- Kelurahan akad nikah Tanggal Tangan Keterangan
Laporan pencatatan
Urut Bila duda atau janda jelaskan bungannya dengan calon d. Pembantu dilangsungkan akta nikah PPN
c. Akta cerai/kutipan buku pendaftaran talak/cerai istri) PPn

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d. Surat keterangan matinya suami/istri
1 2 3 4 5 6 7 8 9 10 11

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Catatan : kolom 7 s/d 10 diisi oleh PPN

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Lampiran 25 PMA No. 2 Tahun 1990

- Pasal 4 ayat (2) –

You're Reading a Preview

Model N10

Upload your documentsBUKU

toCATATAN
download.
KEHENDAK NIKAH

Nama Pembantu PPN : …………………………………………………

OR
Kelurahan : …………………………………………………
Kecamatan : …………………………………………………
Kabupaten/Kotamadya : …………………………………………………
Propinsi : …………………………………………………

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