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yrat PEMERINTAH KABUPATEN CILACAP

PERANGKAT DAERAH
Jalan ........ Nomor ..., Desa/Kel. ...., Kec. ...., Kab. ..., Prov. ..., Kode Pos ...,
Telepon .............., Faksimile ................,
Laman : www.cilacapkab.xxx.go.id, Pos-el : xxx@cilacapkab.go.id

Cilacap, ${tanggal_naskah}
Nomor : ${nomor_naskah}
Sifat : ${sifat}
Lampiran : ............................
Hal : ..............................

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Nama Jabatan
${ttd_pengirim}
Nama
Pangkat
NIP

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