Surat Izin.docx
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PEMERINTAH KABUPATEN SUKABUMI DINAS KESEHATAN
UPTD PUSKESMAS CIBITUNG Jl. Raya Cikaso KM 6 Tlp. Kecamatan Cibitung, Kabupaten Sukabumi e-mail : [email protected] Kode Pos 43172
SURAT IZIN NOMOR
/
/PKM/
/2019
TENTANG ..................................................... .....................................................
Dasar
: a. Nama
........................................................................................
b. Jabatan ........................................................................................ MEMBERI IZIN : Kepada
:
Nama
: ............................................................................................................
Jabatan
: ............................................................................................................
Alamat
: ............................................................................................................
untuk
:
................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ...................................................................................................................................
Ditetapkan di Cibitung Pada Tanggan / /2019 KEPALA UPTD PUSKESMAS CIBITUNG
YOGIANTO, SKM PENATA NIP. 198011172008011004
UPTD PUSKESMAS CIBITUNG Jl. Raya Cikaso KM 6 Tlp. Kecamatan Cibitung, Kabupaten Sukabumi e-mail : [email protected] Kode Pos 43172
SURAT IZIN NOMOR
/
/PKM/
/2019
TENTANG ..................................................... .....................................................
Dasar
: a. Nama
........................................................................................
b. Jabatan ........................................................................................ MEMBERI IZIN : Kepada
:
Nama
: ............................................................................................................
Jabatan
: ............................................................................................................
Alamat
: ............................................................................................................
untuk
:
................................................................................................................................... ................................................................................................................................... ................................................................................................................................... ...................................................................................................................................
Ditetapkan di Cibitung Pada Tanggan / /2019 KEPALA UPTD PUSKESMAS CIBITUNG
YOGIANTO, SKM PENATA NIP. 198011172008011004
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