Transport Kader Jamban

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PEMERINTAH KABUPATEN TEGAL
Mufadilah DINAS KESEHATAN
Mufadilah UPTD PUSKESMAS LEBAKSIU
Mufadilah Alamat : Jl. Bukit Sitanjung No .44 Telp. ( 0283 ) 3466775
Mufadilah 491644 Kode pos 52461
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Kepada Yth : Kepala Dinas Kesehatan Kab.Tegal
Dari : Petugas Puskesmas Lebaksiu
Tanggal : ###
Perihal : Laporan Hasil Kegiatan
Disposisi : LAPORAN
Berdasarkan surat Perintah Tugas Kepala Puskesmas Lebaksiu

Nomor : 800/ 05/ 717 / 2021 Tanggal : 3 November 2021 bersama ini
kami laporkan hasil Kegiatan Up date data sanitasi tahun 2021 Kader Kesehatan
Puskesmas Lebaksiu ke desa Lebaksiu kidul sebagai berikut :
JUMLAH RUMAH/KK DENGAN JAMBAN SEHAT

DESA LEBAKSIU KIDUL RW 2
Nama Rw Jml KK Jml Jiwa Jml Rumah
Jumlah
JUMLAH RUMAH/KK DENGAN JAMBAN TIDAK

SEHAT DESA LEBAKSIU KIDUL RW 2
Jumlah
JUMLAH RUMAH/KK TDAK PUNYA JAMBAN DESA

LEBAKSIU KIDUL RW 2
Jumlah
Lebaksiu Kidul ###

Yang melaporkan
Mengetahui
Lokasi Yang dikunjungi
1 St Khariroh ……………..
DINAS KESEHATAN
UPTD PUSKESMAS LEBAKSIU
Alamat : Jl. Bukit Sitanjung No .44 Telp. ( 0283 ) 3466775
491644 Kode pos 52461
SURAT TUGAS
Nomor : 800 / 05 / 717 / 2021
Yang bertanda tangan dibawah ini Kepala Puskesmas Lebaksiu

dengan ini menugaskan kepada :
No. Nama Jabatan Alamat Tanggal Pelaksanaan

1 Silfia Herlinawati Kader Yamansari RW 1 04 , 18 November 2021
2 Saikhatun Kader Yamansari RW 2 04 , 18 November 2021
3 Bahiyah Kader Yamansari RW 3 04 , 18 November 2021
4 Diana Kader Yamansari RW 4 04 , 18 November 2021
5 Mohamad Tabri Ali Kader Yamansari RW 5 04 , 18 November 2021
6 Fathur Rohman Kader Yamansari RW 6 04 , 18 November 2021
7 M. Sunoto Riyadi
8 Nuridun
9 Uswatun Khasanah
10 Toidin
11 Diana Sari Yamansari RW 7 04 , 18 November 2021
12 Lukman Charis Yamansari RW 8 04 , 18 November 2021
13 Mustofa Yamansari RW 9 04 , 18 November 2021
14 Abdul Muin Yamansari RW 10 04 , 18 November 2021
15 Bambang Yamansari RW 11 04 , 18 November 2021
Untuk Dinas : Kegiatan Kader Up datae Data Sanitasi 2021
Selama : Dua ( 2 ) hari kerja
Tanggal Pelaksanaan : 04 , 18 November 2021

Lokasi : Desa Yamansari
Demikian Surat Tugas ini untuk dapat dilaksanakan dengan penuh tanggung jawab.
i 2016 Lebaksiu , 3 November 2021

Kepala Puskesmas Lebaksiu
Kabupaten Tegal
Dr Bambang Sungkono
NIP. 19620715 198911 1 002
TEGAL
AN
SIU
0283 ) 3466775
Tujuan/Lokasi
Up Date data Sanitasi

asi 2021
ggung jawab.
ember 2021
as Lebaksiu
Tegal
ungkono
98911 1 002
DAFTAR PENERIMAAN :TRANSPORT KADER DALAM RANGKA KEGIATAN UPDATE DATA SANITASI
DI DESA YAMANSARI
PENGELOLAAN PELAYANAN KESEHATAN LINGKUNGAN
PUSKESMAS LEBAKSIU
BULAN : NOVEMBER 2021
JML UANG JML UANG

JML TRANSPORT TRANSPORT
NO. NAMA ALAMAT NPWP NIK PER KEG DIBAYARKAN
KEG
Rp. Rp.
1 Nuziatun Yamansari RW 1 - 3328064306840003 2 30,000 60,000

2 Kholipah Yamansari RW 2 - 3328064401900009 2 30,000 60,000
3 Muasister Yamansari RW 3 - 3328065807850005 2 30,000 60,000
4 Alifah Yamansari RW 4 - 3328064107690007 2 30,000 60,000
5 Ma'muroh Yamansari RW 5 - 3328066904750001 2 30,000 60,000
6 Mujiatun Yamansari RW 6 - 3328065801760002 2 30,000 60,000
7 Nurchikmah Yamansari RW 7 - 3328064411640002 2 30,000 60,000
8 Assafiiyah Yamansari RW 8 - 3328065608680003 2 30,000 60,000
9 Kurningsih Yamansari RW 9 - 3328065505770011 2 30,000 60,000
10 Ita Umami Yamansari RW 10 - 3328064511850006 2 30,000 60,000
11 Yuliawati Yamansari RW 11 - 332806471280003 2 30,000 60,000
660,000
12
Enam ratus enam puluh ribu
rupiah )
Pejabat Pelaksana Teknis

Kegiatan
Ari Dwi Cahyani,SKM,M.Kes

NIP. 19670831 199002 2 003
JML UANG
Pph 21
DITERIMA TANDA TANGAN
Rp. Rp.
3,600 56,400 1 ...................

3,600 56,400 2 ....................
3,600 56,400 3 ...................
3,600 56,400 4 ....................
3,600 56,400 5 ...................
3,600 56,400 6 ....................
3,600 56,400 7 ...................
3,600 56,400 8 ....................
3,600 56,400 9 ...................
3,600 56,400 10 ....................
3,600 56,400 11 ...................
39,600 620,400
( Enam ratus dua puluh ribu empat ratus rupiah )
Slawi, 2021
Bendahara Pengeluaran
Pembantu
Saparatinah Setyo Pratiwi,SE

NIP :19660624 200701 2 022
DAFTAR HADIR : KADER DALAM RANGKA KEGIATAN UPDATE DATA SANITASI
DI DESA YAMANSARI
PENGELOLAAN PELAYANAN KESEHATAN LINGKUNGAN
PUSKESMAS LEBAKSIU
HARI : KAMIS PADA TANGGAL ; 04 NOVEMBER 2021
NO. NAMA JABATAN TANDA-TANGAN
1 Nuziatun Kader 1 ...................
2 Kholipah Kader 2 ………………….
3 Muasister Kader 3 ………………
4 Alifah Kader 4 ………………….
5 Ma'muroh Kader 5 ……………..
6 Mujiatun Kader 6 ………………….
7 Nurchikmah Kader 7 …………….. ………………….
8 Assafiiyah Kader …………….. 8 ………………….
9 Kurningsih Kader 9 …………….. ………………….
10 Ita Umami Kader …………….. 10 ………………….
11 Yuliawati Kader 11 ……………..
Yamansari , ; 04 NOVEMBER 2021
Pejabat Pelaksana Teknis Kepala Puskesmas Lebaksiu

Kegiatan Kabupaten Tegal
Ari Dwi Cahyani,SKM,M.Kes dr . Bambang Sungkono

NIP. 19670831 199002 2 003 NIP. 19620715 198911 1 002
DINAS KESEHATAN
491644 Kode pos 52461
SURAT TUGAS
Nomor : 800 / 05 / / 2020

Tanggal
No. Nama Jabatan Alamat
Pelaksanaan
Tujuan/Lokasi
1 Kristin Kader Kesuben Pos 1 03 September 2020 Validasi Stunting

2 Sugiarti Kader Kesuben Pos 2 03 September 2020 Validasi Stunting
3 Nur Baeti Kader Kesuben Pos 3 03 September 2020 Validasi Stunting
4 St Qoniah Kader Kesuben Pos 4 03 September 2020 Validasi Stunting
5 Paricha Kader Kesuben Pos 5 03 September 2020 Validasi Stunting
6 Suharti Kader Kesuben Pos 6 03 September 2020 Validasi Stunting
7 Atikah Kader Kesuben Pos 7 03 September 2020 Validasi Stunting
8 Mulyati Kader Kesuben Pos 8 03 September 2020 Validasi Stunting
9 Nina Meliana Kader Kesuben Pos 9 03 September 2020 Validasi Stunting
10 Jaetun Kader Kesuben Pos 10 03 September 2020 Validasi Stunting
11 Khasila Kader Kesuben Pos 11 03 September 2020 Validasi Stunting
12 Mahmudah Kader Kesuben Pos 12 03 September 2020 Validasi Stunting
Untuk Dinas : Kegiatan Kader Validasi Stunting
Selama : Satu ( 1 ) hari kerja

Tanggal
Pelaksanaan : 03 September 2020
Lokasi : Desa Dukuhlo
uari 2016 Lebaksiu , 2 September 2020

Kabupaten Tegal
Dr Bambang Sungkono
NIP. 19620715 198911 1 002
DAFTAR PENERIMAAN : TRANSPORT KADER DALAM RANGKA KEGIATAN PENDAMPINGAN PEMANTAUAN STATUS
DI DESA DUKUHLO RW I
KEGIATAN OPERASIONAL KESEHATAN
PUSKESMAS LEBAKSIU
BULAN : JANUARI 2019
NO. NAMA ALAMAT NPWP NIK JML KEG
1 Siti Mulyanah Dukuhlo RW 1 - 3328064502680004 1

2 Kasilem Dukuhlo RW 1 - 3328065405720002 1
3 Endang Suryaningsih Dukuhlo RW 1 - 3328074711720002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DAFTAR PENERIMAAN : TRANSPORT KADER DALAM RANGKA KEGIATAN PEMANTAUAN STATUS GIZI
DI DESA DUKUHLO RW 7
PUSKESMAS LEBAKSIU
1 Puji Rahayu Dukuhlo RW 7 - 3328064909800012 1

2 Widiawati Dukuhlo RW 7 - 3328065809820004 1
3 Nunung Dukuhlo RW 7 - 3328064304780004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Kartika Sari Dukuhlo RW 6 - 3328066010780005 1

2 Sri Nur Baeti Dukuhlo RW 6 - 1
3 Toisah Dukuhlo RW 6 - 3328066811670002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Waijah Dukuhlo RW 5 - 3328066810750002 1

2 Sri Wahyuningsih Dukuhlo RW 5 - 3328064401600001 1
3 Susyanti Dukuhlo RW 5 - 3328067007740003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Sunarsih Dukuhlo RW 4 - 3328064511770003 1

2 Diroh Riyanti Dukuhlo RW 4 - 33280066904770002 1
3 Yuliana Dukuhlo RW 4 - 3328065703810000 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Masitoh Dukuhlo RW 3 - 3328065610710004 1

2 Sudarmi Dukuhlo RW 3 - 3328066203660000 1
3 Nur Aeni Dukuhlo RW 3 - 3328064303800007 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Wasilah Dukuhlo RW 2 - 33280066109680002 1

2 Sori,ah Dukuhlo RW 2 - 3328064906740002 1
3 Ika Setyowati Dukuhlo RW 2 - 3328064102760002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA LEBAKSIU KIDUL RW 3
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Cholipah Lebaksiu Kidul RW 3 - 3328066606620002 1

2 Siti Umaroh Lebaksiu Kidul RW 3 - 3328066704740003 1
3 Siti Muayanah Lebaksiu Kidul RW 3 - 3328065704750003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Mupadilah Lebaksiu Kidul RW 4 - 3328066701720005 1

2 Tuti Nurhayati Lebaksiu Kidul RW 4 - 3328066408780004 1
3 Nurlaeli Lebaksiu Kidul RW 4 - 332806711070007 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Mujayanah Lebaksiu Kidul RW 5 - 3328067011710004 1

2 Umaroh Lebaksiu Kidul RW 5 - 3328065506780009 1
3 Nursalamah Lebaksiu Kidul RW 5 - 3328066907740002 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Jajilah Lebaksiu Kidul RW 6 - 3328066306720002 1

2 Umi Fakhriyah Lebaksiu Kidul RW 6 - 332806660110790007 1
3 Juriyah Lebaksiu Kidul RW 6 - 3328067112508096 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Malikhatun Lebaksiu Kidul RW 1 - 3328066909830004 1

2 Anipah Lebaksiu Kidul RW 1 - 3328065001730003 1
3 Muawanah Lebaksiu Kidul RW 1 - 3328065707730003 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Animah Lebaksiu Kidul RW 2 - 3328065504660013 1

2 Muspaidah Lebaksiu Kidul RW 2 - 332806471170002 1
3 Khariroh Lebaksiu Kidul RW 2 - 3328066711740002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA TIMBANGREJA RW 4, 5
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Sri Widiyanti Timbangreja RW 4,5 - 3328064403730001 1

2 Sugiarti Timbangreja RW 4,5 - 3328065205760010 1
3 Khurul Aeni Timbangreja RW 4,5 - 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA TIMBANGREJA RW 6,7
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Nuriyah Timbangreja RW 6,7 - 3328066804670003 1

2 Latifah Timbangreja RW 6,7 - 3328064206790004 1
3 Siti Rohimah Timbangreja RW 6,7 - 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA TIMBANGREJA RW 8
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017

1 Nurkhayanah Timbangreja RW 8 - 3328067004720001 1
2 Muasiroh Timbangreja RW 8 - 3328065506890007 1
3 Khaerunisa Timbangreja RW 8 - 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Ma'muroh Timbangreja RW 2 - 3328066202740002 1

2 Habsiyah Timbangreja RW 2 - 1
3 Muprikhatun Timbangreja RW 2 - 3328064104790005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017

1 Nurhayati Timbangreja RW 3 - 3328064906730003 1

2 Fatkhuroh Timbangreja RW 3 - 3328064107690236 1
3 Tuti Alawiyah Timbangreja RW 3 - 3328064710740004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Alfiyah Timbangreja RW 1 - 3328065412780002 1

2 Mukimah Timbangreja RW 1 - 1
3 Juayati Timbangreja RW 1 - 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA LEBAKSIU LOR RW 2
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Sufaeroh Lebaksiu Lor RW 2 - 3328065706660002 1

2 Siti Nurhayati Lebaksiu Lor RW 2 - 1
3 Sukrisni Lebaksiu Lor RW 2 - 3328066511650008 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Surani Lebaksiu Lor RW 7 - 3328061801110246 1

2 Lela Nurhayati Lebaksiu Lor RW 7 - 1
3 Dita Anwar Lebaksiu Lor RW 7 - 3328061801110198 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Masamah Lebaksiu Lor RW 6 - 1

2 Wiwin Meliyana Lebaksiu Lor RW 6 - 3328064604820005 1
3 Maani Lebaksiu Lor RW 6 - 3328064505540001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Matoyah Lebaksiu Lor RW 8 - 1

2 Nurhidayah Lebaksiu Lor RW 8 - 3328064404710009 1
3 Miftahul Janah Lebaksiu Lor RW 8 - 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Musbiroh Lebaksiu Lor RW 5 - 3328066907760003 1

2 Nur Hikmah Lebaksiu Lor RW 5 - 3328066306810004 1
3 Maghfiroh Lebaksiu Lor RW 5 - 3328066808800005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Duryati Lebaksiu Lor RW 1 - 332806650965001 1

2 Lely Asrofi Lebaksiu Lor RW 1 - 3328064403720001 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : JUNI 2017
1 Wastiah Lebaksiu Lor RW 3 - 3328065006580001 1

2 Sugestiningsih Lebaksiu Lor RW 3 - 3328065102660002 1
3 Masitroh Lebaksiu Lor RW 3 - 3328066404720003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : FEBRUARI 2017

1 Suparni Lebaksiu Lor RW 4 - 3328064107660188 1
2 Kheriyah Lebaksiu Lor RW 4 - 3328067105670001 1
3 Muhibah Lebaksiu Lor RW 4 - 3328064107630018 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 9
PUSKESMAS LEBAKSIU
1 Solikha Kajen RW 9 - 3328066501660001 1

2 Saeruroh Kajen RW 9 - 3328065810720001 1
3 Tasripah Kajen RW 9 - 3328066811660001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 6,7,8
PUSKESMAS LEBAKSIU
1 Khanipah Kajen RW 6,7,8 - 1

2 Eni Suryani Kajen RW 6,7,8 - 3328064808690005 1
3 Toyibah Kajen RW 6,7,8 - 3328065710580002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 5
PUSKESMAS LEBAKSIU
1 Wahyu S Kajen RW 5 - 3328066412790005 1

2 Titi S Kajen RW 5 - 3328064512740003 1
3 Desi Irawati Kajen RW 5 - 3328064412770002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 3,4
PUSKESMAS LEBAKSIU
1 Maemanah Kajen RW 3,4 - 3328066803750003 1

2 Rosia Kajen RW 3,4 - 3328065707650003 1
3 Heni Yulianti Kajen RW 3,4 - 3328066512760002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Siti Jahro Kajen RW 1,2 - 3328065208710003 1

2 Nurayati Kajen RW 1,2 - 3328064903670004 1
3 Sri Wiyati Kajen RW 1,2 - 3328065900010005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA YAMANSARI RW 1
PUSKESMAS LEBAKSIU
1 Taslikhatun Yamansari RW I - 332806610569000 1

2 Sri Madyaningsih Yamansari RW I - 3328064211660000 1
3 Subarti Yamansari RW I - 3328066402670003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Sidiningsih Yamansari RW 2 - 3328045306590005 1

2 Turisah Yamansari RW 2 - 3328064501580000 1
3 Sri Mulyaningsih Yamansari RW 2 - 3328065707620001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Muasister Yamansari RW 3 - 3328065807850005 1

2 Ana Istighfaroh Yamansari RW 3 - 3328064 202760003 1
3 Hindun Yamansari RW 3 - 3328068403970003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Alipah Yamansari RW 4 - 3328064107690001 1

2 Khunaenah Yamansari RW 4 - 3328067112650016 1
3 Fifi Arofiani Yamansari RW 4 - 3328066711760002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA YAMANSARI RW 5,6
PUSKESMAS LEBAKSIU
1 Dakhori Yamansari RW 5,6 - 3328063112560025 1

2 Ma,muroh Yamansari RW 5,6 - 3328066904750001 1
3 Chamidah Yamansari RW 5,6 - 3328064703740001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Nurul Ma'fuah Yamansari RW 7 - 3328066905770009 1

2 Alami Yamansari RW 7 - 3328066901820003 1
3 Zahrotul Fikriyah Yamansari RW 7 - 3328065110880001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Was'ari Yamansari RW 8 - 3328060107520026 1

2 Kamilah Yamansari RW 8 - 3328064604570002 1
3 Naimah Yamansari RW 8 - 33280641076100 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Siti Rahayu Yamansari RW 9 - 3328066008720003 1

2 Asyafi'iyah Yamansari RW 9 - 3328065608680003 1
3 Kurningsoh Yamansari RW 9 - 3328065505770011 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA YAMANSARI RW 10, 11
PUSKESMAS LEBAKSIU
1 Yuliawati Yamansari RW 10, 11 - 332806471280003 1

2 Indrawati Yamansari RW 10, 11 - 3328066901800006 1
3 Neli Ustati Yamansari RW 10, 11 - 3328067101820002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA JATIMULYA RW 5,6
PUSKESMAS LEBAKSIU
1 Nur Laela Hayati Jatimulya RW 5,6 - 3328065803820001 1

2 Maskunah Jatimulya RW 5,6 - 3328064605650006 1
3 Turisah Jatimulya RW 5,6 - 3328065807840003 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA JATIMULYA RW 4
PUSKESMAS LEBAKSIU
1 Sri Hartuti Jatimulya RW 4 - 3328064404640008 1

2 Efi Suswati Jatimulya RW 4 - 3328066001830001 1
3 Nurlaela Jatimulya RW 4 - 3328065803820001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Indah Kurniati Jatimulya RW 3 - 3328106210760001 1

2 Muniroh Jatimulya RW 3 - 3328066912740002 1
3 Sunengsih Jatimulya RW 3 - 3328106210760001 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Umi Sodikoh Jatimulya RW 2 - 3328066108720005 1

2 Khalimah Jatimulya RW 2 - 3328066410710002 1
3 Saeruroh Jatimulya RW 2 - 3328065311730006 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Sri Rokhayati Jatimulya RW 1 - 332806500172009 1

2 Rochani Jatimulya RW 1 - 3328065408720001 1
3 Komariyah Jatimulya RW 1 - 3328115205870009 1
3

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KESUBEN RW 4
PUSKESMAS LEBAKSIU
1 Nuraeningsih Kesuben RW 4 - 3328066709710001 1

2 Mulyani Kesuben RW 4 - 3328064809410004 1
3 Aeni Kesuben RW 4 - 3328065005520004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Sumarti Kesuben RW 6 - 3328065208680004 1

2 Suharti Kesuben RW 6 - 3328065704730001 1
3 Jaromi Kesuben RW 6 - 3328066108710002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Siti Juweriyah Kesuben RW 5 - 3328064509800002 1

2 Karsini Kesuben RW 5 - 3328064509680002 1
3 Reni Ade Astuti Kesuben RW 5 - 3328065806900015 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU

1 Siti Wasitoh Kesuben RW 3 - 3328064411780002 1

2 Nurbaeti Kesuben RW 3 - 3328065105800006 1
3 Nuratika Kesuben RW 3 - 3328067010820001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Endang Nasikhatun Kesuben RW 2 - 3328065908790008 1

2 Nur Khomisah Kesuben RW 2 - 332806461187003 1
3 Masruroh Kesuben RW 2 - 3328064304750012 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Kristin Kesuben RW 1 - 332806420278004 1

2 Yati Kesuben RW 1 - 3328064212890011 1
3 Kasni Kesuben RW 1 - 3328065204770007 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Mahmudah Kesuben RW 12 - 3328064608750002 1

2 Nur Amaliyah Kesuben RW 12 - 3328064111820002 1
3 Syaripah Kesuben RW 12 - 3328065407750008 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Muaeni Kesuben RW 11 - 3328064712690003 1

3 Sulastri Kesuben RW 11 - 3328065109650004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU

2 Tarwi Kesuben RW 10 - 3328064410620002 1
3 Zaenun Nilawati Kesuben RW 10 - 3328064107820211 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Roisah Kesuben RW 9 - 3328065408680002 1

2 Nina Meliana Kesuben RW 9 - 3328066004800009 1
3 Yeni Kesuben RW 9 - 332806804770002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Rohyatun Kesuben RW 8 - 3328066704700003 1

2 Atikah Kesuben RW 8 - 3328065307720005 1
3 Mulyati Kesuben RW 8 - 3328065603800003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
1 Fauziyati Kesuben RW 7 - 3328064312610002 1


Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA TIMBANGREJA RW 4, 5
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Malikhatun Timbangreja RW 4,5 - 3328066210790000 1

2 Sugiarti Timbangreja RW 4,5 - 3328065205760010 1
3 Khurotul Aeni Timbangreja RW 4,5 - 3328066601800000 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA TIMBANGREJA RW 6,7
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Mursilah Timbangreja RW 6,7 - 3328065508760007 1

2 Nuriyah Timbangreja RW 6,7 - 3328066804670003 1
3 Latifah Timbangreja RW 6,7 - 3328064206790004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Ria Sidik Timbangreja RW 8 - 3328066610840002 1

2 Muasiroh Timbangreja RW 8 - 3328065506890007 1
3 Fika Nurhidayati Timbangreja RW 8 - 3328064409890003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Habsiyah Timbangreja RW 2 - 3328065205720004 1

2 Mamuroh Timbangreja RW 2 - 3328066202740002 1
3 Khalimah Timbangreja RW 2 - 3328066202740002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Tuti Alawiyah Timbangreja RW 3 - 3328064710740004 1

2 Siti Asiyah Timbangreja RW 3 - 3328066003760010 1
3 Nurhayati Timbangreja RW 3 - 3328064906730003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Juayati Timbangreja RW 1 - 3328066203680002 1

2 Mukimah Timbangreja RW 1 - 3328065506720001 1
3 Qoniah Timbangreja RW 1 - 3328164301760003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Ida Turyatun Lebaksiu Lor RW 2 - 3328066511650008 1

2 Sufaeroh Lebaksiu Lor RW 2 - 3328065706660002 1
3 Umi Kulsum Lebaksiu Lor RW 2 - 3328066309740005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Surani Lebaksiu Lor RW 7 - 3328062602080185 1

2 Lela Nurhayati Lebaksiu Lor RW 7 - 3328061801110246 1
3 Sumiati Lebaksiu Lor RW 7 - 3328060803084777 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Eni Iriyani Lebaksiu Lor RW 6 - 3328065009690021 1

2 Masamah Lebaksiu Lor RW 6 - 3328064903640003 1
3 Wiwin Meliyana Lebaksiu Lor RW 6 - 3328064604820005 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Nurhidayah Lebaksiu Lor RW 8 - 3328064404710009 1

2 Miftahul Janah Lebaksiu Lor RW 8 - 3328065001670011 1
3 Matoyah Lebaksiu Lor RW 8 - 3328060212120011 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nur Hikmah Lebaksiu Lor RW 5 - 3328066306810004 1

2 Maghfiroh Lebaksiu Lor RW 5 - 3328066808800005 1
2
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Mursiyah Lebaksiu Lor RW 1 - 3328065803650001 1

2 Duryati Lebaksiu Lor RW 1 - 332806650965001 1
3 Lely Asrofi Lebaksiu Lor RW 1 - 3328064403720001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Masitoh Lebaksiu Lor RW 3 - 3328066404720003 1

2 Saadah Lebaksiu Lor RW 3 - 3328065108660004 1
3 Rina F Lebaksiu Lor RW 3 - 3328066907760003 1
3

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Muhibah Lebaksiu Lor RW 4 - 3328064107630018 1

2 Suparni Lebaksiu Lor RW 4 - 3328064107660188 1
3 Kheriyah Lebaksiu Lor RW 4 - 3328067105670001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA JATIMULYA RW 5,6
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Maskunah Jatimulya RW 5,6 - 3328064605650006 1

2 Turisah Jatimulya RW 5,6 - 3328065807840003 1
3 Latifah Jatimulya RW 5,6 - 3328065206840005 1
3

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Sri Hartuti Jatimulya RW 4 - 3328064404640008 1

2 Wasri Jatimulya RW 4 - 3328066001520001 1
3 Efi Suswati Jatimulya RW 4 - 3328066001830001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Apriyani Jatimulya RW 3 - 3328064404670004 1

2 Muniroh Jatimulya RW 3 - 3328066912740002 1
3 Indah Kurniati Jatimulya RW 3 - 3328106210780001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Umi Sodikoh Jatimulya RW 2 - 3328066108720005 1

2 Saeruroh Jatimulya RW 2 - 3328065311730006 1
3 Khalimah Jatimulya RW 2 - 3328066410710002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017

1 Fatimah Jatimulya RW 1 - 3328066505750000 1

2 Komariyah Jatimulya RW 1 - 3328115205870009 1
3 Sri Agustina Jatimulya RW 1 - 3328065708620002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Mulyani Kesuben RW 4 - 3328064809410004 1

2 Nur Aeningsih Kesuben RW 4 - 3328066709710001 1
3 Aeni Kesuben RW 4 - 3328065005520004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Suharti Kesuben RW 6 - 3328065704730001 1

2 Sumarti Kesuben RW 6 - 3328065208680004 1
3 Jaromi Kesuben RW 6 - 3328066108710002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Kartini Kesuben RW 5 - 3328064509680002 1

2 Siti Juweriyah Kesuben RW 5 - 3328064509800002 1
3 Reni Ade Astuti Kesuben RW 5 - 3328065806900015 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nur Baeti Kesuben RW 3 - 3328065105800006 1

2 Siti Wasitoh Kesuben RW 3 - 3328064411780002 1
3 Nur Atikah Kesuben RW 3 - 3328067010820001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nur Khomisah Kesuben RW 2 - 332806461187003 1

2 Endang Nasikhatun Kesuben RW 2 - 3328065908790008 1
3 Masruroh Kesuben RW 2 - 3328064304750012 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Yati Kesuben RW 1 - 3328064212890011 1

2 Kristin Kesuben RW 1 - 332806420278004 1
3 Kasni Kesuben RW 1 - 3328065204770007 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nur Amalah Kesuben RW 12 - 3328064111820002 1

3 Syaripah Kesuben RW 12 - 3328065407750008 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Muaeni Kesuben RW 11 - 3328064712690003 1


Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Tarwi Kesuben RW 10 - 3328064410620002 1

3 Zaenun Nilawati Kesuben RW 10 - 3328064107820211 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Yeni Kesuben RW 9 - 332806804770002 1

2 Nina Meliana Kesuben RW 9 - 3328066004800009 1
3 Nanik Widiawati Kesuben RW 9 - 3328065302780001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Atikah Kesuben RW 8 - 3328065307720005 1

3 Siti Baroyah Kesuben RW 8 - 3328065203670002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017

2 Fauziyati Kesuben RW 7 - 3328064312610002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Siti Umaroh Lebaksiu Kidul RW 3 - 3328066704740003 1

2 Cholipah Lebaksiu Kidul RW 3 - 3328066606620002 1
3 Muayanah Lebaksiu Kidul RW 3 - 3328065704750003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Tuti Nurhayati Lebaksiu Kidul RW 4 - 3328066408780004 1

2 Nurlaeli Lebaksiu Kidul RW 4 - 332806711070007 1
3 Mupadilah Lebaksiu Kidul RW 4 - 3328066701720005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Mujayanah Lebaksiu Kidul RW 5 - 3328067011710004 1

2 Umroh Lebaksiu Kidul RW 5 - 3328065506780009 1
3 Nursalamah Lebaksiu Kidul RW 5 - 3328066907740002 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Juriyah Lebaksiu Kidul RW 6 - 3328067112508096 1

2 Umi Fakhriyah Lebaksiu Kidul RW 6 - 332806660110790007 1
3 Jajilah Lebaksiu Kidul RW 6 - 3328066306720002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Muawanah Lebaksiu Kidul RW 1 - 3328065707730003 1

2 Anipah Lebaksiu Kidul RW 1 - 3328065001730003 1
3 Malikhatun Lebaksiu Kidul RW 1 - 3328066909830004 1
3
Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Animah Lebaksiu Kidul RW 2 - 3328065504660013 1

2 Khariroh Lebaksiu Kidul RW 2 - 3328066711740002 1
3 Muspaidah Lebaksiu Kidul RW 2 - 332806471170002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Faizah Yamansari RW I - 3328065512750005 1

2 Sri Madyaningsih Yamansari RW I - 3328064211660000 1
3 Subarti Yamansari RW I - 3328066402670003 1
3

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Sri Mulyani Yamansari RW 2 - 3328065707620001 1

2 Kholipah Yamansari RW 2 - 3328064401900009 1
3 Titi Istanti Yamansari RW 2 - 3328064505720003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : April 2017
1 Nur Aeni Yamansari RW 3 - 3328066604770002 1

2 Lilis Yamansari RW 3 - 3328064404840005 1
3 Muasister Yamansari RW 3 - 3328065807850005 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Alipah Yamansari RW 4 - 3328064107690001 1

2 Khunaenah Yamansari RW 4 - 3328067112650016 1
3 Ita Anisa Yamansari RW 4 - 3328064607830014 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA YAMANSARI RW 5,6
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017

1 Dakhori Yamansari RW 5,6 - 3328063112560025 1

2 Chamidah Yamansari RW 5,6 - 3328064703740001 1
3 Mujiatun Yamansari RW 5,6 - 3328065801760002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nurul Ma'fuah Yamansari RW 7 - 3328066905770009 1

2 Zahrotul Fikriyah Yamansari RW 7 - 3328065110880001 1
3 Setianingsih Yamansari RW 7 - 3328065903850001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Kamilah Yamansari RW 8 - 3328064604570002 1

2 Naimah Yamansari RW 8 - 33280641076100 1
3 Nurhikmah Yamansari RW 8 - 3328064411640002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Siti Rahayu Yamansari RW 9 - 3328066008720003 1

2 Kurningsih Yamansari RW 9 - 3328065505770011 1
3 Juwanti Yamansari RW 9 - 3328065504710003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA YAMANSARI RW 10, 11
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Indrawati Yamansari RW 10, 11 - 3328066901800006 1

2 Yuliawati Yamansari RW 10, 11 - 332806471280003 1
3 Nur Diana Yamansari RW 10, 11 - 3328065601820002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
q TRANSPORT KADER DALAM RANGKA KEGIATAN PEMANTAUAN STATUS GIZI

DI DESA KAJEN RW 9
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Eliyah Kajen RW 9 - 3328065205680003 1

2 Nur Azizah Kajen RW 9 - 3328064606850004 1
3 Tasripah Kajen RW 9 - 3328066811660001 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 6,7,8
PUSKESMAS LEBAKSIU
BULAN : APRIL . 2017
1 Kholipah Kajen RW 6,7,8 - 3328065710580002 1

2 Toyibah Kajen RW 6,7,8 - 3328065710580002 1
3 Khomisah Kajen RW 6,7,8 - 3328065710580002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
DI DESA KAJEN RW 5
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Lilis Ekowati Kajen RW 5 - 3328066205710004 1

2 Wahyu Kajen RW 5 - 3328066412790005 1
3 Titi Sugiarti Kajen RW 5 - 3328064512740003 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Rosia Kajen RW 3,4 - 3328065707650003 1

2 Maemanah Kajen RW 3,4 - 3328066803750003 1
3 Heni Yulianti Kajen RW 3,4 - 3328066512760002 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PUSKESMAS LEBAKSIU
BULAN : APRIL 2017
1 Nurbaya Kajen RW 1,2 - 3328065010670005 1

2 Siti Jahro Kajen RW 1,2 - 3328065208710003 1
3 Nurayati Kajen RW 1,2 - 3328064903670004 1

Kegiatan
Slamet, SKM
NIP. 19710614 200003 1 007
PINGAN PEMANTAUAN STATUS GIZI
JML UANG JML UANG

JML UANG
TRANSPORT TRANSPORT Pph 21
PER KEG DIBAYARKAN DITERIMA TANDA TANGAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

( Tujuh puluh lima ribu rupiah ) (Tujuh puluh ribu lima ratus rupiah )
Slawi, Januari 2019

Pelaksana Teknis Bendahara Pengeluaran
Pembantu
lamet, SKM Moch. Farhamul Atfal

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 20 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 19 Januari 2019

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 19 JANUARI 2019

Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 20 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 20 Juni 2017

Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 19 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 17 Juni 2017
Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 17 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 17 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 17 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 22 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................
25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 20 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
TANDA TANGAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 1 9 MEI 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 19 Juni 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
TRANSPOR TRANSPORT Pph 21
T PER KEG DIBAYARKAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

( Tujuh puluh lima ribu
(Tujuh puluh ribu lima ratus rupiah )
rupiah )
Slawi, 19 Juni 2017

Pembantu
amet, SKM Moch. Farhamul Atfal

0614 200003 1 007 NIP : 197708212009031002
MANTAUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

rupiah )
Slawi, 19 Juni 2017

Pembantu

0614 200003 1 007 NIP : 197708212009031002
MANTAUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

rupiah )
Slawi, 13 Februari 2017

Pembantu

0614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................
25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
TANDA TANGAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Slawi, 20 April 2017

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ...................
25,000 25,000 1,500 23,500 3 ....................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ...................
25,000 25,000 1,500 23,500 3 ....................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
TANDA TANGAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500

Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
TANDA TANGAN
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI

JML UANG JML UANG
JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu

10614 200003 1 007 NIP : 197708212009031002
AUAN STATUS GIZI
JML UANG JML UANG

JML UANG
Rp. Rp. Rp. Rp.
25,000 25,000 1,500 23,500 1 ...................

25,000 25,000 1,500 23,500 2 ....................
25,000 25,000 1,500 23,500 3 ...................
75,000 4,500 70,500


Pembantu
10614 200003 1 007 NIP : 197708212009031002
DINAS KESEHATAN
491644 Kode pos 52461
SURAT TUGAS
Nomor : 800 / 05 / / 2020

Tanggal
No. Nama Jabatan Alamat
Pelaksanaan
Tujuan/Lokasi
1 Sukeni Kader Yamansari RW 1 9 dan 23 Juni 2020 Pemantauan jentik berkala

2 Nuziatun Kader Yamansari RW 1 9 dan 23 Juni 2020 Pemantauan jentik berkala
3 Sidi Ingsih Kader Yamansari RW 2 9 dan 23 Juni 2020 Pemantauan jentik berkala
4 Kholipah Kader Yamansari RW 2 9 dan 23 Juni 2020 Pemantauan jentik berkala
5 Muasister Kader Yamansari RW 3 9 dan 23 Juni 2020 Pemantauan jentik berkala
6 Mastukha Kader Yamansari RW 3 9 dan 23 Juni 2020 Pemantauan jentik berkala
7 Alipah Kader Yamansari RW 4 9 dan 23 Juni 2020 Pemantauan jentik berkala
8 Retno Putri Kader Yamansari RW 4 9 dan 23 Juni 2020 Pemantauan jentik berkala
9 Dakhori Kader Yamansari RW 5,6 9 dan 23 Juni 2020 Pemantauan jentik berkala
10 Ma'muroh Kader Yamansari RW 5,6 9 dan 23 Juni 2020 Pemantauan jentik berkala
11 Nur Khikmah Kader Yamansari RW 7 9 dan 23 Juni 2020 Pemantauan jentik berkala
12 Zahrotun Fikriya Kader Yamansari RW 7 9 dan 23 Juni 2020 Pemantauan jentik berkala
13 Assafiiyah Kader Yamansari RW 8 9 dan 23 Juni 2020 Pemantauan jentik berkala
14 Diana Kader Yamansari RW 8 9 dan 23 Juni 2020 Pemantauan jentik berkala
15 Kurningsih Kader Yamansari RW 9 9 dan 23 Juni 2020 Pemantauan jentik berkala
16 Indrawati Kader Yamansari RW 9 9 dan 23 Juni 2020 Pemantauan jentik berkala
17 Ita Umami Kader Yamansari RW 10, 11 9 dan 23 Juni 2020 Pemantauan jentik berkala
18 Yuliawati Kader Yamansari RW 10, 11 9 dan 23 Juni 2020 Pemantauan jentik berkala
Untuk Dinas : Kegiatan Kader Pemantauan Jentik Berkala

Selama : Dua ( 2 ) hari kerja
Tanggal
Pelaksanaan : 9 dan 23 Juni 2020
Lokasi : Desa Yamansari
ari 2016 Lebaksiu ,8 Juni 2020

Kabupaten Tegal
Dr Bambang Sungkono
NIP. 19620715 198911 1 002
DAFTAR PENERIMAAN : TRANSPORT KADER DALAM RANGKA KEGIATAN PENDAMPINGAN PENDATAAN SASARAN BAYI DAN BALITA
DI DESA YAMANSARI
PUSKESMAS LEBAKSIU
JML UANG JML UANG JML

JML TRANSPORT TRANSPORT Pph 21 UANG
NO. NAMA ALAMAT NPWP NIK PER KEG DIBAYARKAN DITERIMA TANDA TANGAN
KEG
Rp. Rp. Rp. Rp.
1 Taslikhatun Yamansari RW 1 - 332806610569000 1 30,000 30,000 1,800 28,200 1 ............

2 Sri Madyaningsih Yamansari RW 1 - 3328064211660000 1 30,000 30,000 1,800 28,200 2 ...........
3 Sidiningsih Yamansari RW 2 - 3328045306590005 1 30,000 30,000 1,800 28,200 3 ...........
4 Turisah Yamansari RW 2 - 3328064501580000 1 30,000 30,000 1,800 28,200 4 ...........
5 Muasister Yamansari RW 3 - 3328065807850005 1 30,000 30,000 1,800 28,200 5 ...........
6 Ana Istighfaroh Yamansari RW 3 - 3328064 202760003 1 30,000 30,000 1,800 28,200 6 ...........
7 Alipah Yamansari RW 4 - 3328064107690001 1 30,000 30,000 1,800 28,200 7 ...........
8 Khunaenah Yamansari RW 4 - 3328067112650016 1 30,000 30,000 1,800 28,200 8 ...........
9 Dakhori Yamansari RW 5,6 - 3328063112560025 1 30,000 30,000 1,800 28,200 9 ...........
10 Ma'muroh Yamansari RW 5,6 - 3328066904750001 1 30,000 30,000 1,800 28,200 10 ...........
11 Nurul Ma'fuah Yamansari RW 7 - 3328066905770009 1 30,000 30,000 1,800 28,200 11 ...........
12 Alami Yamansari RW 7 - 3328066901820003 1 30,000 30,000 1,800 28,200 12 ...........
13 Asyafi'iyah Yamansari RW 8 - 3328065608680003 1 30,000 30,000 1,800 28,200 13 ...........
14 Aniatun Yamansari RW 8 - 3328064502680004 1 30,000 30,000 1,800 28,200 14 ...........
15 Siti Rahayu Yamansari RW 9 - 3328066008720003 1 30,000 30,000 1,800 28,200 15 ...........
16 Kurningsih Yamansari RW 9 - 3328065505770011 1 30,000 30,000 1,800 28,200 16 ...........
17 Yuliawati Yamansari RW 10, 11 - 332806471280003 1 30,000 30,000 1,800 28,200 17 ...........
18 Indrawati Yamansari RW 10, 11 - 3328066901800006 1 30,000 30,000 1,800 28,200 18 ...........
2 540,000 32,400 507,600
(Lima ratus empat puluh
(Lima ratus tujuh ribu enam ratus rupiah )
ribu rupiah )
Slawi,
Pejabat Pelaksana Teknis Bendahara Pengeluaran
Kegiatan Pembantu
Slamet, SKM Moch. Farhamul Atfal

NIP. 19710614 200003 1 007 NIP : 197708212009031002
DI DESA DUKUHLO
PUSKESMAS LEBAKSIU
JML
JML JML
UANG
UANG
TRANSPO UANG
TRANSPO
RT
Pph 21
NO. NAMA ALAMAT NPWP NIK JML KEG RT PER DITERIM TANDA TANGAN
DIBAYARK A
KEG
AN
Rp. Rp. Rp. Rp.
1 Siti Mulyanah Dukuhlo RW 1 - 3328064502680004 1 30,000 30,000 1,800 28,200 1 ............

2 Kasilem Dukuhlo RW 1 - 3328065405720002 1 30,000 30,000 1,800 28,200 2 ...........
3 Wasilah Dukuhlo RW 2 - 33280066109680002 1 30,000 30,000 1,800 28,200 3 ...........
4 Sori'ah Dukuhlo RW 2 - 3328064906740002 1 30,000 30,000 1,800 28,200 4 ...........
5 Masitoh Dukuhlo RW 3 - 3328065610710004 1 30,000 30,000 1,800 28,200 5 ...........
6 Sudarmi Dukuhlo RW 3 - 3328066203660000 1 30,000 30,000 1,800 28,200 6 ...........
7 Sunarsih Dukuhlo RW 4 - 3328064511770003 1 30,000 30,000 1,800 28,200 7 ...........
8 Diroh Riyanti Dukuhlo RW 4 - 33280066904770002 1 30,000 30,000 1,800 28,200 8 ...........
9 Waijah Dukuhlo RW 5 - 3328066810750002 1 30,000 30,000 1,800 28,200 9 ...........
10 Sri Wahyuningsih Dukuhlo RW 5 - 3328064401600001 1 30,000 30,000 1,800 28,200 10 ...........
11 Kartika Sari Dukuhlo RW 6 - 3328066010780005 1 30,000 30,000 1,800 28,200 11 ...........
12 Sri Nur Baeti Dukuhlo RW 6 - 33280643022710005 1 30,000 30,000 1,800 28,200 12 ...........
13 Puji Rahayu Dukuhlo RW 7 - 3328064909800012 1 30,000 30,000 1,800 28,200 13 ...........
14 Widiawati Dukuhlo RW 7 - 3328065809820004 1 30,000 30,000 1,800 28,200 14 ...........
2 420,000 25,200 394,800
(Empat ratus dua (Tiga ratus sembilan puluh empat ribu
puluh ribu rupiah ) delapan ratus rupiah )
Slawi, 2019
Kegiatan Pembantu

NIP. 19710614 200003 1 007 NIP : 197708212009031002
DAFTAR PENERIMAAN : TRANSPORT KADER DALAM RANGKA KEGIATAN PENDAMPINGAN KELUARGA SEHAT
DI DESA DUKUHLO
PUSKESMAS LEBAKSIU
JML
JML JML
UANG
UANG
TRANSPO UANG
TRANSPO
RT
Pph 21
NO. NAMA ALAMAT NPWP NIK JML KEG RT PER DITERIM TANDA TANGAN
DIBAYARK A
KEG
AN
Rp. Rp. Rp. Rp.
1 Siti Mulyanah Dukuhlo RW 1 - 3328064502680004 1 30,000 30,000 1,800 28,200 1 ............

2 Kasilem Dukuhlo RW 1 - 3328065405720002 1 30,000 30,000 1,800 28,200 2 ...........
3 Wasilah Dukuhlo RW 2 - 33280066109680002 1 30,000 30,000 1,800 28,200 3 ...........
4 Sori'ah Dukuhlo RW 2 - 3328064906740002 1 30,000 30,000 1,800 28,200 4 ...........
5 Masitoh Dukuhlo RW 3 - 3328065610710004 1 30,000 30,000 1,800 28,200 5 ...........
6 Sudarmi Dukuhlo RW 3 - 3328066203660000 1 30,000 30,000 1,800 28,200 6 ...........
7 Sunarsih Dukuhlo RW 4 - 3328064511770003 1 30,000 30,000 1,800 28,200 7 ...........
8 Diroh Riyanti Dukuhlo RW 4 - 33280066904770002 1 30,000 30,000 1,800 28,200 8 ...........
9 Waijah Dukuhlo RW 5 - 3328066810750002 1 30,000 30,000 1,800 28,200 9 ...........
10 Sri Wahyuningsih Dukuhlo RW 5 - 3328064401600001 1 30,000 30,000 1,800 28,200 10 ...........
11 Kartika Sari Dukuhlo RW 6 - 3328066010780005 1 30,000 30,000 1,800 28,200 11 ...........
12 Sri Nur Baeti Dukuhlo RW 6 - 33280643022710005 1 30,000 30,000 1,800 28,200 12 ...........
13 Puji Rahayu Dukuhlo RW 7 - 3328064909800012 1 30,000 30,000 1,800 28,200 13 ...........
14 Widiawati Dukuhlo RW 7 - 3328065809820004 1 30,000 30,000 1,800 28,200 14 ...........
2 420,000 25,200 394,800
(Empat ratus dua (Tiga ratus sembilan puluh empat ribu
puluh ribu rupiah ) delapan ratus rupiah )
Slawi, Januari 2019
Kegiatan Pembantu

NIP. 19710614 200003 1 007 NIP : 197708212009031002
DI DESA TIMBANGREJA
PUSKESMAS LEBAKSIU

KEG
Rp. Rp. Rp. Rp.
1 Alfiyah Timbangreja RW 1 - 3328065412780002 1 30,000 30,000 1,800 28,200 1 ............

2 Mukimah Timbangreja RW 1 - 3328065506720001 1 30,000 30,000 1,800 28,200 2 ...........
3 Ma'muroh Timbangreja RW 2 - 3328066202740002 1 30,000 30,000 1,800 28,200 3 ...........
4 Muprikhatun Timbangreja RW 2 - 3328064104790005 1 30,000 30,000 1,800 28,200 4 ...........
5 Nurhayati Timbangreja RW 3 - 3328064906730003 1 30,000 30,000 1,800 28,200 5 ...........
6 Fatkhuroh Timbangreja RW 3 - 3328064107690236 1 30,000 30,000 1,800 28,200 6 ...........
7 Sri Widiyanti Timbangreja RW 4,5 - 3328064403730001 1 30,000 30,000 1,800 28,200 7 ...........
8 Sugiarti Timbangreja RW 4,5 - 3328065205760010 1 30,000 30,000 1,800 28,200 8 ...........
9 Nuriyah Timbangreja RW 6,7 - 3328066804670003 1 30,000 30,000 1,800 28,200 9 ...........
10 Latifah Timbangreja RW 6,7 - 3328064206790004 1 30,000 30,000 1,800 28,200 10 ...........
11 Nurkhayanah Timbangreja RW 8 - 3328067004720001 1 30,000 30,000 1,800 28,200 11 ...........
12 Muasiroh Timbangreja RW 8 - 3328065506890007 1 30,000 30,000 1,800 28,200 12 ...........
2 360,000 21,600 338,400
(Tiga ratus enam puluh ribu (Tiga ratus tiga puluh delapan ribu empat
rupiah ) ratus rupiah )
Slawi,
Kegiatan Pembantu

NIP. 19710614 200003 1 007 NIP : 197708212009031002
DAFTAR PENERIMAAN :TRANSPORT KADER DALAM RANGKA KEGIATAN PENDAMPINGAN PENDATAAN SASARAN BAYI DAN BALITA
DI DESA LEBAKSIU LOR
PUSKESMAS LEBAKSIU

KEG
Rp. Rp. Rp. Rp.
1 Duryati Lebaksiu Lor RW 1 - 332806650965001 1 30,000 30,000 1,800 28,200 1 ............

2 Lely Asrofi Lebaksiu Lor RW 1 - 3328064403720001 1 30,000 30,000 1,800 28,200 2 ...........
3 Sufaeroh Lebaksiu Lor RW 2 - 3328065706660002 1 30,000 30,000 1,800 28,200 3 ...........
4 Sukrisni Lebaksiu Lor RW 2 - 3328066511650008 1 30,000 30,000 1,800 28,200 4 ...........
5 Masitoh Lebaksiu Lor RW 3 - 3328066404720003 1 30,000 30,000 1,800 28,200 5 ...........
6 Sugestiningsih Lebaksiu Lor RW 3 - 3328065102660002 1 30,000 30,000 1,800 28,200 6 ...........
7 Suparni Lebaksiu Lor RW 4 - 3328064107660188 1 30,000 30,000 1,800 28,200 7 ...........
8 Kheriyah Lebaksiu Lor RW 4 - 3328067105670001 1 30,000 30,000 1,800 28,200 8 ...........
9 Musbiroh Lebaksiu Lor RW 5 - 3328066907760003 1 30,000 30,000 1,800 28,200 9 ...........
10 Nur Hikmah Lebaksiu Lor RW 5 - 3328066306810004 1 30,000 30,000 1,800 28,200 10 ...........
11 Maani Lebaksiu Lor RW 6 - 3328064505540001 1 30,000 30,000 1,800 28,200 11 ...........
12 Wiwin Meliyana Lebaksiu Lor RW 6 - 3328064604820005 1 30,000 30,000 1,800 28,200 12 ...........
13 Surani Lebaksiu Lor RW 7 - 3328061801110246 1 30,000 30,000 1,800 28,200 13 ...........
14 Dita Anwar Lebaksiu Lor RW 7 - 3328061801110198 1 30,000 30,000 1,800 28,200 14 ...........
15 Matoyah Lebaksiu Lor RW 8 - 3328060212120011 1 30,000 30,000 1,800 28,200
16 Miftahul Janah Lebaksiu Lor RW 8 - 3328066606620002 1 30,000 30,000 1,800 28,200
2 480,000 28,800 451,200

(Empat ratus delapan (Empat ratus lima puluh satu ribu dua ratus
puluh ribu rupiah ) rupiah )
Slawi,
Kegiatan Pembantu

NIP. 19710614 200003 1 007 NIP : 197708212009031002
DI DESA KAJEN
PUSKESMAS LEBAKSIU

KEG
Rp. Rp. Rp. Rp.
1 Siti Jahro Kajen RW 1,2 - 3328065208710003 1 30,000 30,000 1,800 28,200 1 ............
2 Nurayati Kajen RW 1,2 - 3328064903670004 1 30,000 30,000 1,800 28,200 2 ...........
3 Maemanah Kajen RW 3,4 - 3328066803750003 1 30,000 30,000 1,800 28,200 3 ...........
4 Rosia Kajen RW 3,4 - 3328065707650003 1 30,000 30,000 1,800 28,200 4 ...........
5 Wahyu S Kajen RW 5 - 3328066412790005 1 30,000 30,000 1,800 28,200 5 ...........
6 Titi S Kajen RW 5 - 3328064512740003 1 30,000 30,000 1,800 28,200 6 ...........
7 Khanipah Kajen RW 6,7,8 - 3328066511650008 1 30,000 30,000 1,800 28,200 7 ...........
8 Eni Suryani Kajen RW 6,7,8 - 3328064808690005 1 30,000 30,000 1,800 28,200 8 ...........
9 Solikha Kajen RW 9 - 3328066501660001 1 30,000 30,000 1,800 28,200 9 ...........
10 Saeruroh Kajen RW 9 - 3328065810720001 1 30,000 30,000 1,800 28,200 10 ...........
11 Heny Yuliati Kajen RW 10 - 3328066512760002 1 30,000 30,000 1,800 28,200 11 ...........
12 Esti Kajen RW 10 - 1 30,000 30,000 1,800 28,200 12 ...........
2 360,000 21,600 338,400
(Tiga ratus enam puluh ribu (Tiga ratus tiga puluh delapan ribu empat
rupiah ) ratus rupiah )
Slawi,
Kegiatan Pembantu

NIP. 19710614 200003 1 007 NIP : 197708212009031002

Transport Kader Jamban

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Berdasarkan surat Perintah Tugas Kepala Puskesmas Lebaksiu

JUMLAH RUMAH/KK DENGAN JAMBAN SEHAT

JUMLAH RUMAH/KK DENGAN JAMBAN TIDAK

JUMLAH RUMAH/KK TDAK PUNYA JAMBAN DESA

Lebaksiu Kidul ###

Yang bertanda tangan dibawah ini Kepala Puskesmas Lebaksiu

No. Nama Jabatan Alamat Tanggal Pelaksanaan

Untuk Dinas : Kegiatan Kader Up datae Data Sanitasi 2021

Selama : Dua ( 2 ) hari kerja

Tanggal Pelaksanaan : 04 , 18 November 2021

i 2016 Lebaksiu , 3 November 2021

Up Date data Sanitasi

JML UANG JML UANG

1 Nuziatun Yamansari RW 1 - 3328064306840003 2 30,000 60,000

Pejabat Pelaksana Teknis

Ari Dwi Cahyani,SKM,M.Kes

3,600 56,400 1 ...................

( Enam ratus dua puluh ribu empat ratus rupiah )

Saparatinah Setyo Pratiwi,SE

NO. NAMA JABATAN TANDA-TANGAN

1 Nuziatun Kader 1 ...................

2 Kholipah Kader 2 ………………….

3 Muasister Kader 3 ………………

4 Alifah Kader 4 ………………….

5 Ma'muroh Kader 5 ……………..

6 Mujiatun Kader 6 ………………….

7 Nurchikmah Kader 7 …………….. ………………….

8 Assafiiyah Kader …………….. 8 ………………….

9 Kurningsih Kader 9 …………….. ………………….

10 Ita Umami Kader …………….. 10 ………………….

11 Yuliawati Kader 11 ……………..

Yamansari , ; 04 NOVEMBER 2021

Pejabat Pelaksana Teknis Kepala Puskesmas Lebaksiu

Ari Dwi Cahyani,SKM,M.Kes dr . Bambang Sungkono

Yang bertanda tangan dibawah ini Kepala Puskesmas Lebaksiu

1 Kristin Kader Kesuben Pos 1 03 September 2020 Validasi Stunting

Untuk Dinas : Kegiatan Kader Validasi Stunting

Selama : Satu ( 1 ) hari kerja

uari 2016 Lebaksiu , 2 September 2020

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Siti Mulyanah Dukuhlo RW 1 - 3328064502680004 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Puji Rahayu Dukuhlo RW 7 - 3328064909800012 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Kartika Sari Dukuhlo RW 6 - 3328066010780005 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Waijah Dukuhlo RW 5 - 3328066810750002 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Sunarsih Dukuhlo RW 4 - 3328064511770003 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Masitoh Dukuhlo RW 3 - 3328065610710004 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Wasilah Dukuhlo RW 2 - 33280066109680002 1

Pejabat Pelaksana Teknis

NO. NAMA ALAMAT NPWP NIK JML KEG

1 Cholipah Lebaksiu Kidul RW 3 - 3328066606620002 1