Anda di halaman 1dari 1

TANDA TERIMA

Telah diterima dari :

_____________________________________________________________________

Berupa :

_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Yang diterima oleh :

_____________________________________________________________________

Untuk keperluan :

_____________________________________________________________________
_____________________________________________________________________

Jakarta, .....,....................

Penerima Pengirim

( ) ( )