PEMERINTAH KABUPATEN BOMBANA

KECAMATAN KABAENA TIMUR

DESA BALO
Kantor : Jalan Poros Dongkala-Sikeli, Desa Balo 93783 email : pemdesabalo@gmail.com

BERITA ACARA
Nomor : / BA-DBL/ / 2023

Pada Hari ini, ............................. Tanggal ............................. Bulan .....................................Tahun

................................................................................ bertempat di : .................................................................... telah

dilaksanakan ....................................................................................................................................................................
..............................................................................................................................................................................................
yang dihadiri oleh aparat pemerintahan Desa, dan unsur lain yang terkait.

Materi atau Topik yang dibahas dalam pertemuan/musyawarah ini, serta yang bertindak
selaku unsur Pimpinan Rapat dan Nara sumber adalah :

A. Materi atau Topik

1. ........................................................................................................................................................................
2. ........................................................................................................................................................................
3. ........................................................................................................................................................................
4. ........................................................................................................................................................................
5. ........................................................................................................................................................................
6. ........................................................................................................................................................................
7. ........................................................................................................................................................................
8. ........................................................................................................................................................................
B. Unsur Pimpinan Rapat dan Nara Sumber :

Pemimpin Rapat : .............................................. Dari ..............................................

Notulen : .............................................. Dari ..............................................
Narasumber : 1. .............................................. Dari ..............................................
2. .............................................. Dari ..............................................
3. .............................................. Dari ..............................................
4. .............................................. Dari ..............................................

Setelah dilakukan Pembahasan dan diskusi terhadap materi atau topik diatas, selanjutnya
seluruh peserta menyetujui serta menyepakati beberapaka hal yang berketetapan
menjadi keputusan akhir dari pertemuan tersebut:

..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................

Demikian Berita Acara ini dibuat dan disahkan dengan penuh rasa tangggungjawab agar
dapat dipergunakan sebagaimana mestinya.

Balo, ................................... 2023

Kepala Desa Balo, Ketua BPD Desa Balo Notulen,

(ADEMAN, S.Si) (RAHMAT HIDAYAT) ( SYARIFUDIN )

Mengetahui dan Menyetujui,

Wakil dari Peserta Pertemuan

No. Nama Alamat Tanda tangan

1
1. 2.
2

3
3. 4.
4

5
5. 6.
6

..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
..............................................................................................................................................................................................
 SUSUNAN ACARA

1. Pembukaan
2. Menyanyikan Lagu Indonesia Raya
3. Kata Pengantar Bapak Kepala Desa Balo
sekaligus membuka acara dengan resmi
4. Kata sambutan :
 Bapak Camat Kabaena Timur
 Bapak Kapolsek Kabaena Timur
 Bapak Kepala Kejaksaan Negeri Bombana
 .
 .
5. Pembacaan Doa
6. Istrahat
(dilanjutkan dengan acara penyuluhan/peningkatan kapasitas aparat pemerintahan desa
Forum diserahkan kepada Pemateri)

SUSUNAN ACARA

7. Pembukaan
8. Menyanyikan Lagu Indonesia Raya
9. Kata Pengantar Bapak Kepala Desa Balo
sekaligus membuka acara dengan resmi
10. Kata sambutan :
 Bapak Camat Kabaena Timur
 Bapak Kapolsek Kabaena Timur
 Bapak Kepala Kejaksaan Negeri Bombana
 .
 .
11. Pembacaan Doa
12. Istrahat
(dilanjutkan dengan acara penyuluhan/peningkatan kapasitas aparat pemerintahan desa
Forum diserahkan kepada Pemateri)