TENTANG
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Menimbang : a. bahwa
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b. bahwa ……………..
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c. dan seterusnya;
Mengingat : 1. Undang-Undang
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2. Peraturan Pemerintah
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3. dan seterusnya
MEMUTUSKAN
KESATU : ......................................................................................
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KEDUA : .....................................................................................
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KETIGA : ……………………………………….................................;
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KEEMPAT : ........................................................................................
Ditetapkan di : ......................
KEPALA