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PEMERINTAH KABUPATEN BONE BOLANGO

KECAMATAN ...............................
DESA ...............................
Jl. ................ Desa ..............................., Kec. ...............................

BERITA ACARA
MUSYAWARAH DESA PENETAPAN DATA SDGs DESA
TAHUN 2021 DESA ......

Dalam rangka pelaksanaan Pendataan Desa berbasis Sustainable Development


Goals (SDGs) Desa Tahun 2021, di Desa ……… Kecamatan ……… Kabupaten
Bone Bolango Provinsi Gorontalo maka pada :
Hari dan Tanggal : ...........................................................................
Jam : .................................................................
Tempat : ...........................................................................
Telah dilaksanakan Musyawarah Desa SDGs Tahun 2021 yang dihadiri oleh
Pemerintah Desa, BPD, dan Wakil Kelompok Masyarakat Desa serta unsur lain
yang terkait sebagaimana daftar hadir terlampir. Adapun materi yang dibahas
dalam Musyawarah ini serta yang bertindak selaku unsur Pimpinan musyawarah
dan narasumber adalah sebagai berikut:
A. Agenda/Materi
1. Penyampaian Pencapaian SDGs Desa
2. Evaluasi dan Pembahasan Pencapaian SDGs Desa Tahun 2021;
3. Penetapan SDGs Desa menjadi dasar RPJMDes dan RKP Desa Tahun
berikutnya.
4. ………………………………………………………………………………….
B. Unsur Pimpinan Musyawarah dan Narasumber
1. Pimpinan Musdes : ………………………............ dari Ketua BPD
2. Notulen : ………………………............. dari Anggota BPD
3. Narasumber : 1. ………………………......... dari Kepala Desa
2. ………………………......... dari Kecamatan
3. ………………………......... dari PLD/PD
Setelah dilakukan pembahasan dan diskusi terhadap materi, selanjutnya seluruh
peserta musyawarah Desa menyepakati beberapa hal yang berketetapan menjadi
kesepakatan akhir dari musyawarah Desa Penetapan Data SDGs Desa tahun
2021 yaitu:
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Keputusan diambil secara musyawarah mufakat.


Demikian berita acara ini dibuat dan disahkan dengan penuh tanggungjawab
agar dapat dipergunakan sebagaimana mestinya.

..............................., ...... ................ 2021


Mengetahui : Ketua BPD,
Kepala Desa,

_______________________ _______________________

Mengetahui dan Menyetujui,


Wakil dan peserta Musyawara Desa Khusus

No Nama Alamat Tanda Tangan


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PEMERINTAH KABUPATEN BONE BOLANGO
KECAMATAN ...............................
DESA ...............................
Jl. ................ Desa ..............................., Kec. ...............................

NOTULENSI
MUSYAWARAH DESA PENETAPAN DATA SDGs DESA
TAHUN 2021
Hari/Tanggal : …….........……………
Waktu : …….........……………
Tempat : …….........……………
Agenda : …….........……………
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PEMERINTAH KABUPATEN BONE BOLANGO


KECAMATAN ...............................
DESA ...............................
Jl. ................ Desa ..............................., Kec. ...............................

Daftar Hadir

No Nama Alamat Tanda Tangan


Mengetahui : Ketua BPD,
Kepala Desa,

_______________________ _______________________

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