BERITA ACARA

MUSYAWARAH DESA (MD)

GAMPONG SEUKEE
Dalam rangka Pelaksanaan dana desa di Gampong Seukee Kecamatan Simpang Tiga Kabupaten Pidie
Provinsi Aceh, maka pada :

Hari dan Tanggal :

Jam :
Tempat :

Telah diselenggarakan pertemuan atau Musyawarah Gampong tentang Stunting untuk 1000 hpk yang dihadiri
oleh wakil-wakil dari masyarakat desa serta unsur lain yang terkait sebagaimana tercantum dalam lampiran Daftar
Hadir.

Materi atau topik yang dibahas dalam Forum ini serta yang bertindak selaku unsur pimpinan Rapat dan Narasumber
adalah :

A. Materi atau Topik

1. .................................................................................................................................................
2. .................................................................................................................................................
3. .................................................................................................................................................
4. .................................................................................................................................................
5. .................................................................................................................................................
6. .................................................................................................................................................
7. .................................................................................................................................................

B. Unsur Pimpinan Rapat dan Narasumber

Pemimpin Rapat : ……………….. dari
Sekretaris/Notulis : ……………….. dari
Narasumber : 1. ………………….. dari
2. ………………….. dari
3. ………………….. dari

Setelah dilakukan pembahasan terhadap materi atau topic di atas selanjutnya seluruh peserta musyawarah
memutuskan dan menyepakati beberapa hal yang berketetapan menjadi Keputusan Akhir dari Musyawarah Desa
yaitu :

1. ………………………………………………………………………………………………………………………………
2. ………………………………………………………………………………………………………………………………
3. ………………………………………………………………………………………………………………………………
4. ………………………………………………………………………………………………………………………………
5. ………………………………………………………………………………………………………………………………
6. ………………………………………………………………………………………………………………………………
7. ………………………………………………………………………………………………………………………………
8. ………………………………………………………………………………………………………………………………
9. ………………………………………………………………………………………………………………………………
Demikian Berita Acara ini dibuat dan disahkan dengan penuh tanggung jawab agar dapat dipergunakan
sebagaimana mestinya.

………………., … ……….. 2019

Notulis / Sekretaris

(…………..……………..)
Mengetahui:
Keuchik Gampong Seukee

(………….…..………………..)

Mengetahui dan Menyetujui:

Wakil dari Peserta Musyawarah

Nama Alamat Tanda Tangan

1. ………………………………. ………………… ………………..

2. ………………………………. ………………… ………………..

3. ………………………………. ………………… ………………..

4. ………………………………. ………………… ………………..

5. ………………………………. ………………… ………………..

 NOTULENSI

Tanggal :
Gampong :
Notulensi :

Nara Sumber : 1.

2.

3.

4.

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KESIMPULAN

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