CIROYOM MANDIRI

CIROYOM RELIGI
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Jl. Raya Cirata No.61 E-Mail : desaciroyom2018@gmail.com Kode Pos 40558

FORMULIR
PENDATAAN WARGA (Tanah Aset Desa)

NO. .....................................

NAMA KEPALA KELUARGA : .....................................................................................................

TEMPAT, TANGGAL LAHIR : .....................................................................................................

PEKERJAAN .....................................................................................................

ALAMAT : .....................................................................................................
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JENIS SEWA/PENGGUNAAN : Rumah Tempat Usaha Rumah + Tempat Usaha

LUAS : ................................................... M 2

BLOK .....................................................................................................

JUMLAH PEMBAYARAN : ................................................... - Tahun

SEWA SEJAK : .....................................................................................................

...................... , .......................... 2019

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