BERITA ACARA

MUSYAWARAH KAMPUNG
TENTANG PERENCANAAN KAMPUNG
DALAM RANGKA PENYUSUNAN RKP KAMPUNG TAHUN 2023

Berkaitan dengan pelaksanaan kegiatan musyawarah Kampung, di Kampung Klalomon

Distrik Klamono Kabupaten Sorong Provinsi Papua Barat dalam rangka Penyusunan RKP
Kampung tahun 2023, maka pada hari ini:

Hari dan Tanggal : ............., ................... 20...

Jam : ................................................................
Tempat : ................................................................

telah diadakan kegiatan musyawarah kampung tentang perencanaan kampung, yang telah dihadiri
oleh wakil-wakil kelompok, dusun dan tokoh masyarakat, serta unsur lain yang terkait Kampung
sebagaimana tercantum dalam daftar hadir terlampir.

Materi yang dibahas, serta yang bertindak selaku unsur pimpinan rapat dan narasumber
dalam membahas kegiatan musyawarah Kampung tentang perencanaan Kampung adalah:

A. Materi
1. Penyampaian Rancangan RKP Kampung dan DU-RKP Kampung;
2. Penyampaian Pandangan Resmi BPD yang diperoleh dari serap aspirasi dan/atau
informasi lainnya; dan
3. Aspirasi masyarakat peserta Musyawarah Kampung.
B. Unsur Pimpinan Rapat dan Narasumber
Pemimpin Musyawarah : …..…………………….............. dari ..............
Notulen : …..…………………….............. dari ..............
Narasumber : 1. …..…………………….......... dari ..............
2. …..…………………….......... dari ..............
3. ……………………………… dari ..............

Setelah dilakukan pembahasan dan diskusi terhadap materi, selanjutnya seluruh peserta
musyawarah Kampung menyepakati beberapa hal yang berketetapan menjadi kesepakatan
akhir dari musyawarah Kampung tentang perencanaan Kampung yaitu:

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Keputusan diambil secara musyawarah mufakat/aklamasi dan pemungutan suara/voting.

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

Klalomon, ..... - ...................... - 2023

Kepala Kampung Klalomon Ketua BPD,

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Wakil Masyarakat,

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 NOTULENSI

Agenda Kegiatan : Musyawarah Kampung tentang Perencanaan Kampung.

Hari dan Tanggal : ………………, ……, …………… 20...
Jam : ......................................................
Notulen:
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Klalomon, ..... - ………....... - 2023

Notulis,

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 DAFTAR HADIR
MUSYAWARAH KAMPUNG
TENTANG PERENCANAAN KAMPUNG
DALAM RANGKA PENYUSUNAN RKP KAMPUNG TAHUN 20...

Hari/Tanggal : ............., ....................... 20..

Jam : .................... WIB
Tempat : ................................................
Jumlah Peserta : .............. orang
Laki-laki : ................ orang, Perempuan : ................ orang
JABATAN/ TANDA
NO NAMA L/P ALAMAT
UNSUR TANGAN
1. 1.
2. 2.
3. 3.
4. 4.
5. 5.
6. 6.
7. 7.
8. 8.
9. 9.
10. 10.
11. 11.
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22. 22.
23. 23.
24. 24.
25. 25.
26. 26.
27. 27.
28. 28.
29. 29.
30. 30.
31. 31.
 JABATAN/ TANDA
NO NAMA L/P ALAMAT
UNSUR TANGAN
32. 32.
33. 33.
34. 34.
35. 35.
36. 36.
37. 37.
38. 38.
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60. 60.

Klalomon, ..... - ............ - 2023

Kepala Kampung Klalomon Ketua BPD,

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