Form Duk Fajar.docx
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DAFTAR PENDUKUNG DAN PEMENANGAN “FAJAR
kHARISMA”
PADA PEMILIHAN DPRD DAPIL III KEC. ………………………. Kab. SERANG TAHUN 2019
TPS
:…………………..
DESA
RT/RW
:…………………..
KECAMATAN :………………….
KAMPUNG
:………………….
KABUPATEN :………………….
No
NAMA
UMUR
TANDA TANGAN
:…………………
KETERANGAN
1 2 3 4 5 6 7 8 9 10
……………………………………….2019 Menyetujui Kordinator Pemenangan
Penanggung jawab Pemenangan
{…………………………………………………}
{………………………………………………..}
kHARISMA”
PADA PEMILIHAN DPRD DAPIL III KEC. ………………………. Kab. SERANG TAHUN 2019
TPS
:…………………..
DESA
RT/RW
:…………………..
KECAMATAN :………………….
KAMPUNG
:………………….
KABUPATEN :………………….
No
NAMA
UMUR
TANDA TANGAN
:…………………
KETERANGAN
1 2 3 4 5 6 7 8 9 10
……………………………………….2019 Menyetujui Kordinator Pemenangan
Penanggung jawab Pemenangan
{…………………………………………………}
{………………………………………………..}
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