8/19/2019 Surat Ijin Nikah Di Luar Balai

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Perihal : Permohonan Nikah di luar Balai Nikah

Randudongkal, .............................. 201.

Kepada Yth.Bapak Kepala KUA

Kec. Randudongkal

i

Randudongkal

 Assalamu’alaikum Wr. Wb.

engan ini perkenankanlah kami menga!ukan permohonan untuk

melang"ungkan pernikahan di luar Balai Nikah ata" nama :

NA#A : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

B%N : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

engan

NA#A : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

B%N&% : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

Pada

 &AN''A( : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

)AK&U : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

 &*#PA& : $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

engan ala"an "e+agai +erikut :

1. Ke"epakatan Kedua #empelai2..

emikian "urat permohonan ini di+uat dan ata" terka+uln-a

permohonan ini di"ampaikan terima ka"ih.

Wassalamu’alaikum Wr. Wb.

#en-etu!ui PPN Pemohon)ali Nikah /A&%N

. #UK&A#%(U%N $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ 

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