BERITA ACARA

PENELITIAN BERKAS PERSYARATAN BAKAL CALON

PERANGKAT DESA JABATAN SEKRETARIS DESA
Pada hari ini Rabu tanggal empat belas bulan desember tahun dua ribu enam belas (14-122016) bertempat di Balai Desa Jepara Wetan Kecamatan Binangun dengan disaksikan oleh
Panitia Pengawas Tingkat Kecamatan Binangun telah dilaksanakan penelitian berkas
persyaratan tahap I (Satu) dengan hasil sebagai berikut :
1. Nama
: WAWAN SUSENO
Tempat/Tgl. Lahir
: Cilacap, 22 Juli 1990
Alamat
: Jl. Jenderal Sudirman RT 06 RW 02 Desa Jepara Wetan
Nomor Pendaftaran
: 02
Catatan
:
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.....

2. Nama
: WAHYU PRASETYA
Tempat/Tgl. Lahir
: Cilacap, 22 Oktober 1992
Alamat
: Jl. Jenderal Sudirman RT 21 RW 06 Desa Jepara Wetan
Nomor Pendaftaran
: 04
Catatan
:
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.....

3. Nama
: MIFTAKHUL ANWAR
Tempat/Tgl. Lahir
: Cilacap, 22 Desember 1975
Alamat
: Jl. Jenderal Sudirman RT 13 RW 04 Desa Jepara Wetan
Nomor Pendaftaran
: 07
Catatan
:
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.....

4. Nama
: IRFANTO SAFRUDIN AL FARIZI
Tempat/Tgl. Lahir
: Cilacap, 27 April 1982
Alamat
: Jl. Jenderal Sudirman RT 07 RW 02 Desa Jepara Wetan
Nomor Pendaftaran
: 09
Catatan
:
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.....
5. Nama
: YUSUP
Tempat/Tgl. Lahir
: Cilacap, 11 Maret 1975
Alamat
: Jl. Sindujaya RT 25 RW 07 Desa Jepara Wetan
Nomor Pendaftaran
: 12
Catatan
:
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.....

6. Nama
: EKO CIMANTO
Tempat/Tgl. Lahir
: Cilacap, 02 Januari 1991
Alamat
: Jl. Krikil RT 23 RW 06 Desa Jepara Wetan
Nomor Pendaftaran
: 13
Catatan
:
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.....

7. Nama
: SAHONO
Tempat/Tgl. Lahir
: Cilacap, 26 Juni 1985
Alamat
: Jl. Jenderal Sudirman RT 15 RW 05 Desa Jepara Wetan
Nomor Pendaftaran
: 14
Catatan
:
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...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
2

...........................................................................................................................................
.....

8. Nama
: TURIP
Tempat/Tgl. Lahir
: Cilacap, 14 Juni 1982
Alamat
: Jl. Sangkal Putung RT 09 RW 03 Desa Jepara Wetan
Nomor Pendaftaran
: 16
Catatan
:
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.....

9. Nama
: WAWAN RIYADI
Tempat/Tgl. Lahir
: Cilacap, 11 Mei 1989
Alamat
: Jl. Sangkal Putung RT 09 RW 03 Desa Jepara Wetan
Nomor Pendaftaran
: 19
Catatan
:
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.....
10.Nama
: VERRY BUDIARTO
Tempat/Tgl. Lahir
: Cilacap, 09 Februari 1992
Alamat
: Jl. Jenderal Sudirman RT 06 RW 02 Desa Jepara Wetan
Nomor Pendaftaran
: 20
Catatan
:
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.....

11.Nama
: SRI BUDIARTI
Tempat/Tgl. Lahir
: Cilacap, 16 Oktober 1981
Alamat
: Jl. Krikil RT 13 RW 06 Desa Jepara Wetan
Nomor Pendaftaran
: 21
Catatan
:
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...........................................................................................................................................
3

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.....

12.Nama
: SAMSI
Tempat/Tgl. Lahir
: Cilacap, 04 Januari 2016
Alamat
: Jl. Jenderal Sudirman RT 06 RW 02 Desa Jepara Wetan
Nomor Pendaftaran
: 23
Catatan
:
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.....

13.Nama
: TARSIYEM
Tempat/Tgl. Lahir
: Cilacap, 15 Agustus 1986
Alamat
: RT 32 RW 03 Desa Jepara Wetan
Nomor Pendaftaran
: 24
Catatan
:
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.....

14.Nama
: FITRIA RIA FATIMAH
Tempat/Tgl. Lahir
: Cilacap, 27 Maret 1993
Alamat
: Jl. Jenderal Sudirman RT 14 RW 04 Desa Jepara Wetan
Nomor Pendaftaran
: 25
Catatan
:
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.....
Selanjutnya

untuk

kekurangan-kekurangan

sesuai

catatan

tersebut

diatas

diberikan waktu 6 (enam) hari kerja dari tanggal s.d untuk melengkapi berkas
persyaratan.
4

Demikian berita acara ini dibuat untuk dijadikan pedoman pelaksanaan tahap
selanjutnya.

BAKAL CALON PERANGKAT DESA

PANITIA

1 WAWAN SUSENO

: ................

2 WAHYU PRASETYA

3 MIFTAKHUL ANWAR

: ................

IRFANTO SAFRUDIN
AL FARIZI

................

PENGANGKATAN PERANGKAT DESA

KETUA,

................

5 YUSUP

: ................

6 EKO CIMANTO

7 SAHONO

: ................

8 TURIP

9 WAWAN RIYADI

: ................

LEKHAN

................

................

10 VERRY BUDIARTO

................

11 SRI BUDIARTI

: ................

12 SAMSI

13 TARSIYEM

: ................

14 FITRIA RIA FATIMAH

................

................

MENGETAHUI,
PANITIA PENGAWAS TINGKAT KECAMATAN BINANGUN
KETUA,

ANGGOTA,

ANGGOTA,

Drs. AHMAD KHAERUDIN, M.Si

AKP. JAUHARI MUSTOFA

Kapt. Inf. JOKO YUNANTO