PENELITIAN KELENGKAPAN SURAT PENYALURAN DANA ALOKASI DESA (DAD) IV TA.

2022

KECAMATAN ..............................................

Nama Desa : ...................................................................................................................................

Nomor Registrasi : ...................................................... Tanggal Terima : ..............................................

Check List Kelengkapan Permohonan Penyaluran Dana Alokasi Desa:

Surat Pengantar dari Kepala Desa ( 1 Asli + 1 Fotocopy ).

Pakta integritas/Surat Penyataan Tanggung Jawab Mutlak Tahap IV dari Kepala Desa (1 Asli + 1
Fotocopy ).

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KESIMPULAN DOKUMEN : DITERUSKAN / DITOLAK
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Pemeriksa Tim Pendamping Tingkat Kecamatan:

Nama : .................................................................... NIP : ..........................................

Jabatan (Jabatan dalam Tim): ........................................................................................................................

Tanda Tangan / Paraf : ........................................................................................................................

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Keterangan : ........................................................................................................................

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