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Member Name:

Arifah

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Birth father name SUWARNO Aged 40 at time of me being adopted Birth mother name SURTINAH Aged 29 at time of me being adopted I was child number 6 Following information on my birth certificate: My place of birth was: (D.I.Y.) Yogyakarta Special Province Sub- district: Danurejan Neighbourhood: Bausasran Village: Bausasran Street number: Hayum Wuwark 4 Hospital: Bethesda Branch Hospital Mother’s place of residence: (D.I.Y.) Yogyakarta Special Province District: Bantul Sub-district: Pleret Neighbourhood: Kerto Pleret Village: Kerto Pleret My name before it got changed was: Noni I was child number 6

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