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SURAT PERMOHONAN

Lampiran : …..…………………………
Perihal : Permohonan………………..
…………………………….. Kepada Yth,
…………………………..…

di

Yang bertanda tangan dibawah ini :

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

Alasan Mengajukan Permohonan adalah :


ad

1. ................................................................................................................................................
2. ................................................................................................................................................
3. ................................................................................................................................................
m

4. ................................................................................................................................................
.ir

Bersama ini dilampirkan :


1. ...............................................................................................................................................
w

2. ................................................................................................................................................
3. ...............................................................................................................................................
w

4. ...............................................................................................................................................
w

5. ................................................................................................................................................
6. ................................................................................................................................................

demikian agar dipergunakan sebagai bahan pertimbangan

......................, .................
Pemohon

(......................................)

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