PEMERINTAH PEKON PELITA JAYA

KECAMATAN PESISIR SELATAN

KABUPATEN PESISIR BARAT
Alamat : Jl. Lintas Barat Pekon Pelita Jaya kecamatan Pesisir Selatan. Kode Post: 34875

SURAT PERINTAH TUGAS

Nomo : 141 /468/ 2003.VII.04 / 2021

1. Pejabat Berwenang yang Memberi Perintah : KEPALA DESA ( PERATIN)

2. Nama yang Diberi Perintah : MASKUR AZIZ.
3. a. Pangkat dan Golongan (Jika PNS) :
b. Jabatan : KHATIB
c. Gaji Pokok :
d. Tingkat menurut Peraturan Perjalanan :

Silaturahmi para Ustadz/Ulama yang diselenggarakan

4. Maksud Perjalanan Dinas :
oleh BAZNAS

5. Alat angkutan yang dipergunakan : Kendaraan Pribadi

6. a. Tempat Berangkat : Pelita Jaya

b. Tempat Tujuan : Masjid Al-Khotob, Pekon Kampung Jawa, Pesisir Tengah

7. a. Lamanya Perjalanan Dinas : 1 (satu) Hari
b. Tanggal Berangkat : Wednesday, September 15, 2021
c. Tanggal Harus Kembali : Wednesday, September 15, 2021

8. Pengikut : NO Nama Jabatan Ket

1.
2.
3.
4.
5.
9. Pembebanan Anggaran
a. Instansi :
b. Mata Anggaran : APB Pekon
10. Keterangan lain-lain :

Dikeluarkan di : Pelita Jaya

Pada Tanggal : Tuesday, September 15, 2020
Peratin Pelita Jaya

WAWAN ARDI SAPUTRA, S.H.

 Berangkat dari   : Pekon Pelita Jaya
Ke                       : 

Pada tanggal      :

Peratin Pekon Pelita Jaya

WAWAN ARDI SAPUTRA,S.H

Berangkat dari      : Pelita Jaya Tiba di :

Ke :

Pada tanggal           
: Pada tanggal   :
Kepala Kepala

(................................................................) (................................................................)
NIP. NIP.

Berangkat dari         
: : Hotel Horison Jl. R.A Tiba di : Pelita Jaya

Ke                         :   Pelita
: Bandar
Jaya Lampung
Pada tanggal            : Pada tanggal   :
Kepala Peratin Pekon Pelita Jaya

(................................................................) WAWAN ARDI SAPUTRA,S.H

NIP.

Catatan lain-lain : -
 LAPORAN HASIL PERJALANAN DINAS
Hari/ Tanggal :

Tempat :

Acara :

Petugas :

Laporan Hasil :
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Mengetahui Yang melakukan Perjalanan

Peratin Pekon Pelita Jaya

WAWAN ARDI SAPUTRA, S.H. (......................................)

 PEMERINTAH PEKON PELITA JAYA
KECAMATAN PESISIR SELATAN
KABUPATEN PESISIR BARAT
Alamat : Jl. Lintas Barat Pekon Pelita Jaya kecamatan Pesisir Selatan. Kode Post: 34875

SURAT PERINTAH TUGAS

Nomo : 141 / / 2003.VII.04 / 2020