Contoh Und.docx

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PEMERINTAH KOTA TANGERANG SELATAN

DINAS KESEHATAN

UPT PUSKESMAS KAMPUNG SAWAH Jl. Gelatik I Rt.06/01 Kel. Sawah Kec. Ciputat Kota Tangerang Selatan Telp. (021)-74600060, email : [email protected]

Tangerang Selatan, 26 November 2018 No. Perihal

: / / TU : Permohonan Peminjaman Tempat

Kepada Yth. Lurah Kelurahan Sawah Di Tempat

Dengan hormat, Sehubungan dengan akan diadakannya Sosialisasi Jasmani Olahraga yang kan kami adakan pada : Hari

: Kamis

Tanggal

: 29 November 2018

Pukul

: 08.30 WIB s/d Selsai

Demikian Surat permohonan ini kami sampaikan, atas perhatiannya di ucapkan terimakasih.

Kepala UPT Puskesmas Kampung Sawah

ttd dr. Eliwedi Erni NIP. 19701124 200502 2 002

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