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Lampiran 100 Contoh Surat Pernyataan

KOP SEKOLAH

SURAT PERNYATAAN
Yang bertanda tangan di bawah ini

nama :.......................................................................

NIP :......................................................................

pangkat dan golongan : .....................................................................

jabatan :.....................................................................

alamat :....................................................................

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tanggal

Nama Jabatan,

tanda tangan dan cap jabatan/cap dinas

Nama Pejabat
NIP

139

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