Hari :.................................................................................
Tanggal : ..........................................................................
Waktu : .......................................................................
Tempat : ................................................................
Acara : ........................................................................
1.
2.
3.
dan
seterusnya.
${jabatan_pengirim}
${ttd_pengirim}
${nama_pengirim}
PEMBINA TK I
NIP. ${nip_pengirim}