Lampiran : …..…………………………
Perihal : Permohonan………………..
…………………………….. Kepada Yth,
…………………………..…
di
om
Nama :
Alamat :
sebagai wajib pajak PBB atas objek yang terletak di :
Jalan ...................................................................................... Rt. .................... Rw. .....................
.c
Desa / Kelurahan .................................................................. Kec. .................................................
Kab. / Kodya Dati II ........................................................................................................................
Nomor SPPT
ita
: ..........................................................................................................................
Tanggal diterima SPPT : .................................................................................................................
ev
Mohon ............................................................................................................................................
1. ................................................................................................................................................
2. ................................................................................................................................................
3. ................................................................................................................................................
m
4. ................................................................................................................................................
.ir
2. ................................................................................................................................................
3. ...............................................................................................................................................
w
4. ...............................................................................................................................................
w
5. ................................................................................................................................................
6. ................................................................................................................................................
......................, .................
Pemohon
(......................................)