BERITA ACARA MUSYAWARAH DESA

DALAM RANGKA VERIFIKASI DAN VALIDASI DATA

PERCEPATAN PENSASARAN PENGHAPUSAN KEMISKINAN EKSTRIM (P3KE)
DESIL1-3

Pada hari ini, ......... tanggal ........... bulan ............. Tahun .......... bertempat di Desa ............
telah dilaksanakan musyawarah dalam rangka Verifikasi dan Validasi Data Percepatan
Pensasaran Penghapusan kemiskinan Ekstrim (P3KE) Desil1-3 Desa ............ Kecamatan
Kangkung Kabupaten Kendal.
Musyawarah dihadiri oleh unsur Pemerintah Desa, BPD, Lembaga kemasyarakatan Desa,
Petugas Verifikator Desa serta perwakilan masyarakat, sebagaimana daftar hadir terlampir
dengan materi pokok pembahasan sebagai berikut :

A. MATERI ATAU TOPIK

Verifikasi dan validasi Data P3KE Desil 1-3

B. UNSUR PIMPINAN RAPAT DAN NARASUMBER

Pimpinan rapat : ..................................................
Sekretaris / Notulen : ..................................................
Narasumber : ..................................................
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Setelah dilakukan pembahasan dan diskusi terhadap materi, selanjutnya seluruh peserta
musyawarah dusun/kelompok menyepakati beberapa hal yang berketetapan menjadi
kesepakatan akhir dari musyawarah yaitu:

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Dengan Demikian Berita Acara ini dibuat dan disahkan dengan penuh tanggung jawab agar
dapat dipergunakan sebagaimana mestinya.
...nama desa.., ....................... 20...
PIMPINAN RAPAT NOTULIS

………………………………. ……………………………………….
Mengetahui,
KEPALA DESA ………….

…………………………….

Menyetujui,
Wakil dari Peserta Musyawarah

Jenis
Tanda
No Nama Kelamin Alamat
Tangan
(L/P)

1.

2.

3.

4.

dst

NOTULENSI
Agenda Kegiatan : Musyawarah Desa dalam rangka Verifikasi dan Validasi Data
Percepatan Pensasaran Penghapusan kemiskinan Ekstrim (P3KE)
Desil1-3
Hari dan tanggal :
Waktu : Jam ……….WIB s.d selesai
Notulen :
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....nama desa, ..... - ..... - 20...
Notulis,

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 DAFTAR HADIR
MUSYAWARAH DESA VERIFIKASI DAN VALIDASI DATA
PERCEPATAN PENSASARAN PENGHAPUSAN KEMISKINAN EKSTRIM (P3KE)
DESIL1-3

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.

12.
12.

13.
13.

14. 14.
 JABATAN/ TANDA
NO NAMA L/P ALAMAT
UNSUR TANGAN

15.
15.

16.
dan seterusnya.....

....nama desa, ..... - ..... - 20...

Kepala Desa,

Nama, tanda tangan & cap

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