PEMERINTAH KABUPATEN MAJALENGKA

DINAS KESEHATAN
UPTD PUSKESMAS DTP TALAGA
Jalan Jenderal Ahmad Yani No. 21 Talaga Kode Pos : 45463
Tlp. (0233) 319421 Hotline SMS : 082317007272
email : puskesmasdtptalaga@gmail.com

Tempat, Tanggal, Bulan dan Tahun

Nomor : Kepada
Lampiran : Yth. ………………………………………..
Sifat : ……………………………………………..
Hal : Undangan
di -
………………………………..

.......................................................................................
..........
................................................................................................
............
Hari : ..................................................................
Tanggal : ..................................................................
Waktu : ..................................................................
Tempat : ..................................................................
Acara : ..................................................................
....................................................................................
................................................................................................
............
KEPALA UPTD PUSKESMAS
DTP TALAGA,

NAMA DAN GELAR

Pangkat
NIP
Catatan :
1. …………………………
2. …………………………