Nomor : 002/LHP/PM.01.00/K.JT-17.04/2/2024
I. Data Pengawas:
1. Tahapan yang diawasi : Pemungutan Suara dan Penghitungan
Suara Pemilu 2024
2. Nama Pelaksana Tugas : Exza Septiani Harumingtyas
Pengawasan
3. Jabatan : PENGAWAS TPS 002 DESA KEBOLAMPANG
KECAMATAN WINONG KABUPATEN
PATI PROVINSI JAWA TENGAH
4. Nomor Surat Perintah : 007/PM.00.02/K.JT-17.04/01/2024
Tugas
5. Alamat : Desa KEBOLAMPANG TPS 002 RT 03 RW 01
7. Analisa:
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V. Informasi Potensi Sengketa
1. Peristiwa:
a. Peserta Pemilu : ……………………………………………….
b. Tempat Kejadian : ……………………………………………….
c. Waktu Kejadian : ……………………………………………….
2. Obyek Sengketa:
a. Bentuk objek sengketa : ……………………………………………….
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b. Identitas objek sengketa : ……………………………………………….
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c. Hari/Tanggal dikeluarkan : ……………………………………………….
d. Kerugian langsung : ……………………………………………….
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Dokumentasi