I. Data Pengawas
Nama : 1. Yunita Anita Ludji
2. Merlin M. Muloko
3. Yesi Y. Detabai
Jabatan : Ketua, Anggota, Pelaksana Teknis Panwaslu Kec. Rote Tengah
Alamat : Maubesi, Lidamanu
No. Tlp/Hp : 1. 085 239 271 297
2. 081 337 539 163
3. 082 237 236 159
E-Mail :-
II. Menerangkan telah melakukan kegiatan pengawasan, yaitu:
1. Kegiatan I
2. Nama
Alamat
3. Nama
Alamat
3. Bukti-bukti
a. Lampiran Foto
b. ...............................................................................................
c. ...............................................................................................
d. ...............................................................................................
4. Uraian Singkat Kejadian
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Merlin M. Muloko
Yesi Detabai