I. Sumber Dana
A. Kas Masjid Rp………………………………………………………................
B. Infak/ Sumbangan Rp………………………………....................................................
C. Total Rp………………………………....................................................
II. Sumbangan Material
A. ………………………………………………………………………………………………
B. ………………………………………………………………................................................
C. …………………………………………………………………............................................
D. ………………………………………………………………................................................
E. ………………………………………………………………................................................
III. Penggunaan Dana Rp………………………………....................................................
IV. Saldo Rp………………………………....................................................
TTd Ketua,
…………………………………………………