DPTHP1-PPS
…………, ………………………….
Tertanda
Panitia Pemungutan Suara (PPS) Pemberi Tanggapan
(………………………………………………...) (………………………………………………...)
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Model A.1.A.DPTHP1-PPS
TANDA BUKTI
FORMULIR TANGGAPAN MASYARAKAT TERHADAP DPTHP-1
( ........................................) ( .........................................)