PEMERINTAH KABUPATEN TULANG BAWANG BARAT

TIYUH……………………..
KECAMATAN ........................................
Jln. ………............................... Nomor .............. Kecamatan ....................

NOTULEN RAPAT

Rapat : Tindak Lanjut Hasil Fasilitasi Rancangan Peraturan Tiyuh ………………..

tentang Daftar Kewenangan Tiyuh Berdasarkan Hak Asal Usul dan
Kewenangan Lokal Berskala Tiyuh

Hari / Tanggal : ….. …………… 2023

Pukul Panggilan : Pukul 09.00 WIB
Pukul Rapat : Pukul 09.30 WIB s/d Selesai
Tempat : Ruang Rapat Balai Tiyuh……………………
Acara : 1. Pembukaan
2. Pembahasan
3. Penutup.

PIMPINAN RAPAT
Ketua : ………………………………
Sekretaris : ………………………………
Pencatat : ………………………………

PESERTA RAPAT :Daftar hadir Terlampir

KEGIATAN RAPAT : 1. Pembukaan

2. Pembahasan
3. Penutup.

1. Kata Pembukaan :Pimpinan Rapat membuka rapat mengenai Tindak Lanjut Hasil Fasilitasi
Rancangan Peraturan Tiyuh ……………….. tentang Daftar Kewenangan Tiyuh
Berdasarkan Hak Asal Usul dan Kewenangan Lokal Berskala Tiyuh

2. Pembahasan :

I. DASAR
1. ………………………………………………..
2. ………………………………………………..
3. dst.
II. PERMASALAHAN :

1. ………………………………………………………………….
2. ………………………………………………………………….
3. Dst………………

III. ALTERNATIF PEMECAHAN MASALAH :

1. ........................................................
a. ........................................................................................................................................
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b. ........................................................................................................................................
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2. ......................................................
a. .......................................................................................................................................
...........................................................................................................................................
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3. ...............................................
4. ..........................................dst

Demikian notulen rapat ini dibuat untuk dipergunakan sebagaimana mestinya.

PIMPINAN RAPAT,

……………………
 PEMERINTAH KABUPATEN TULANG BAWANG BARAT
TIYUH……………………..
KECAMATAN ........................................
Jln. .............................. Nomor .............. Kecamatan ....................

DAFTAR HADIR RAPAT

TINDAK LANJUT HASIL FASILITASI RANCANGAN PERATURAN TIYUH ………………..
TENTANG DAFTAR KEWENANGAN TIYUH BERDASARKAN HAK ASAL USUL DAN
KEWENANGAN LOKAL BERSKALA TIYUH
……………………………… 2023

NO NAMA INSTANSI JABATAN TANDA TANGAN

1. S KEPALO TIYUH
ARDIMAN
2. RUS SEKRETARIS TIH
YONO
3. ARIYAN LPMT
TO
4. PONIRAH KASIBERDAYAAN

5. SAYUTI BPT

6. MUHAM BENDAUH
AD TOY
7. IWAN OPERATOR
SANUSI
8.

9.

10.

PIMPINAN RAPAT,

……………………………….