KECAMATAN WELAHAN
DESA WELAHAN
Truely declare that I am working/ not working *) as: wiraswasta and average income per
month up to : Rp. 20.000.000 With number of family responsibilities: 2 person *)
Thus I made this letter truly. If the information I provide is not accordance with the actual
conditions. I am ready to accept santion/processedacording to the applicable legal
procedures and provisions.
.............,....................... 2023
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Sincerely
Legal Seal
Rp. 10.000
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Mengetahui
Kepala Desa Welahan
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