1. Hari : ........................
Tanggal : .........................
Jam : .......................
Tempat : .........................
Materi : ......................
2. Pimpinan Rapat : .........................
Peserta : ............................
Hadir :...... Daftar hadir terlampir
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Tempat, tgl/bln/thn
Mengetahui,
Notulis,
Pimpinan Rapat
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