Aplikasi 1721-A2 Dan SPT 1770 S 1770 Ss - Final

APLIKASI PEMBUATAN
A2, 1770SS DAN 1770S-1721
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APLIKASI BUKTI POTONG A2 1770SS 1770S

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IMPOR CSV A2 SPT 1770 SS
TGL. BUKTI POT 3 1 0 1 2 0 2 0
DATA PEMOTONG
KOTA WP Ruteng
NAMA KPP KPP Pratama Ruteng FORM 1721-A2 SPT 1770 S

DATA GAJI
DATA PEMBERI KERJA
TAHUN PAJAK 2023
NAMA INSTANSI / BADAN LAIN DINAS KESEHATAN KABUPATEN MANGGARAI
BENDAHARA DINAS KESEHATAN KABUPATEN

NAMA BENDAHARA (JABATAN)
MANGGARAI TIMUR
NPWP INSTANSI / BADAN 001396290924000
ALAMAT INSTANSI / BADAN LEHONG
NAMA PIMPINAN / PEMOTONG PAJAK FRANSISKA S. BLAANG
NIP PIMPINAN / PEMOTONG PAJAK 19860308 200804 2 002
KOTA BORONG
TANGGAL PEMBUATAN SPT 31012022
PEKERJAAN PEGAWAI NEGERI SIPIL
KLU 96301
No Nama Pegawai NIP / NRP
1 2 3
001 196803191998032003
dr. SURIP TINTIN
002 19761209200501 2 013

DR.HILDEGARDIS D. C. SIBA
003 19830225 200804 2 001

DR. EMILIA HERNAWATI YORINI DORSI
004 19790805 201001 2 025

DR. MARIA YOHANESTA SARNIS
005 19850811 201001 2 032

SUSANA P .RENDO, S. FARM
006 19791121 200501 2 016

PRUDENSIANA E. ANUL,A.MD.KEB
007 19840801 200901 2 001

HINDRAYANTI,S.KEP.NS
008
SIPRIANUS SAN, S.KEP 19840922 201001 1 021
009 198312242010012029
PRANATA KRISTIANI AGAS, S.
010 197302061994031007
TITUS DORNUS
011
BENEDIKTUS SAMSU S. FAR 198105092010011024
012
ROSALIA P. RIADIANI, S.FARM 198509042009032020
013
ASMI YULIANA,SKM 197908252011012009
014
MARIA ANDRI YENI LEO,SKM 198304052011012009
015
YOHANA SAINA MAWAR 19860624 201101 2 024
016
SARDI ARIES DERMAWATI TEFA, 198004192011012007
017 196908051993022002
MARIA D. KENARI,S.MD.KEB
018 197202071998031000
BONEFASIUS DAR
019
SILVIA AGUSTINA RAE,A.MD 19780822 200604 2 035
020
DOMINIKUS E. DE ROSARIO 19771219 200503 1 008
021 19780420 201408 2 001

dr, SICILIA ELISA D.DJADUR
022 1985031120 1 5032005

dr. HESTY PRIYATI MEO
023 19840814 201403 2 001

dr, MARIA HELENA WENE
024 198805122017042013
dr. MARIA FIGILIANA
025 19840902 200604 1 006
SAVERIUS SARIMAN
026 19820920 200903 2 010

MARIA E. UNDUT,S.KEP
027
HELENA YULIANTY SAN, S.KEP 19840819 201101 2 016
028 19851128 201101 2 017

KAROLINA DHARMAWATI, S.KEP
029
ERMELINDA GUSTAFIN ERSAM, S.KEP 19870814 201101 2 017
030 19830203 200903 2 014

BERNADETHA V.S. DIA,S.GZ
031 19850119 201101 2 029

MARIANA YANEGEL, S.KEP
032 19870521 201101 1 008

WOLFRI Y. DAIMAN, S.KEP
033
FABIANUS GANTUS, S.KEP 19820102 201101 1 008
034 19820828 201101 2 014

FEMIDIANA DISTA, S.KM
035 19870726 201212 2 002

YULIANA N. MADA,S.KEP.NS
036 19880417 201212 2 002

ANGELA M.M.KUMAT.S.KEP
037
HILADA H.NADI.S.KEP 19890909 201212 2 002
038
YASINTA KURNIA, A.MD 198208222010012025
039
KRISTINA KORNELIA LUHUR 197405251999032011
040
KORNELIS BEDI,A.MD.KEP 197905012005011015
041
RENSIWATI INUT,SKM 198308032009032007
042
IRENIUS TENA, S.KEP 19840628 201001 1 021
043
LIDIA SANGGUT,S.GZ 198507052009032015
044
ESTAVIANUS B. GALUR, S.KEP 198509202010011023
045
JANUARIUS J. NGABUT, S.KM 198709192010011007
046 19651215 198703 2 014

YUSTINCE SINVIANIE
047 19680810 198903 2 011

SITTI MARIA
048 19670401 198903 2 018

MARIA FATIMA HAYATI
049 19671128 199001 2 001

SISILIA SAMUR
050 19690929 199103 2 015

MARIA DOLOROSA LEE
051
MARIA IVONY DUA BATIK 19710717 199102 2 002
052 19730513 200212 2 004

SOFIA SETIA
053
AGUSTINUS JARUT 19680414 199203 1 013
054 19690612 1993031018

AMIR SARIFUDIN
055 19730120 199312 1 002

XAVERIUS
056 19651231 199603 2 021

YULIANA MIA
057 19710312 200112 2 002

SOFIA ERSI
058 197404132003122003
ADELTRUDIS P. SALINDEHO
059 19770419 200312 2 006

VINCENTIA DOHE
060
MARIA RENYA SENO 19740510 200604 2 031
061 19731129 200012 2 003

ERMELINDA M. NDELANG
062 197211032006042018
PAULINA NINA
063 19730620 200112 2 003

GENOVEVA DAUL
064
ERMELINDA SINCE MAGUL 19780425 200501 2 014
065 197802132004 06 2019

MARIA SUSANA
066
SISILIA MINA ANUL 19780214 200604 2 019
067
ROSALIA NGGIU 19720903 200604 2 012
068 19750309 200604 2 018

YOHANA LAHUNG
069 19733005 200604 2 017

EDELBERTA ERSELI
070
FRANSISKA V.Y. AMPUT 19730614 200604 2 021
071 19690508 199703 2 005

GRASIANA GEGO
072 19770311 199703 1 009

SOFANYE FIRMINUS
073
LIDWINA KIONG 19710410 199803 2 007
074 196804262000121003
RAFAEL MUJA
075 19730902 199703 1 007

SENIN BARU
076 19730803 200012 2 005

MARIA LESTA
077 19750315 199803 2 005

LUSIA E.NDUKANG
078 19750627 199703 2 004

THERESIA
079
LAMBERTIN LANDANG 19781128 200604 2 018
080 19760519 200604 2 017

MARIA JAYA
081 19751104 200604 2 014
KAROLINA DALIA
082 19730517 200604 2 029

EDIRENTIA TELI
083 19710503 200903 2 001

EVENSIA MIMU,A.MD
084 19781015 200604 2 024

OKTAVIANI YUN TERESIA
085 197601202003122007
DOROTEA LALAMUT
086
KAMILUS ADEM SALEMAN 19771714 199903 1 006
087 19780606 200604 2 045

MARIA THERESIA LAWUR
088 19790412 199903 1 003

PASKALIS STANISLAUS JANGKAR
089 19790414 200501 2 027

FRANSISKA ROSIDAWATI
090
KRISPINUS PAKAT,A.MD.KEP 19790205 200501 1 014
19731008 199703 1 005
091
SERGIUS BAKHUS ADI SAMSU DURA
092 19820331 200012 2 001

VERONIKA Y. RAHA
093 19740318 200604 1 011

FERDINANDUS LAWI,A.MD.KEP
094 19760617 200312 2 008

YULIANA ANDUNG
095
MARTA JUNTIANI,A.MD.KEB 19801231 200501 2 025
096
VALENTINUS JAO, A.MD.KEP 19810528 200112 1 004
097
ANGELA M.S. MULYATI,A.MD.KEB 198201252005012005
098 19810609 200501 2 014

ELISABETH AVELINA, A.MD.KEB
099
FRANSISKA VERONIKA MUDAH 19801028 200604 2 033
100 19800805 200604 2 027

YOSEFINA NIRMA,A.MD.KEB
101 19810907 200604 2 021

REGINA NANUS,A.MD
102
ADRIANUS JEBATUNG 19780419 200303 1 001
103 19820801 200501 1 006

YOSEF BUDIMAN,A.MD.KEP
104 19811120 200604 2 016

HERMINA NARU
105 19820515 200604 2 016

ADRIANA E.A.ROBIN,A.MD
106 19820701 200501 1 007

ALEKSIUS DRIHANUL,A.MD.KEP
107 19831003 200604 2 017

THERESIA M.R.D.TODANG, A.MD
108 198202152002122006
EUFRASIA RAMBING
109 19780628 200212 1 003
GERADUS HASU
110 19820530200604 1 010

NOBERTUS MINGGU,A.MD.KEP
111 19821014 200604 1 005

STEFANUS DE ROSARI,A.MD.
112
YASINTA FATIMA JELITA 19820430 200604 2 027
113
MARIANA NELCI MIRDA 19830630 200701 2 003
114 19781123 200212 2 005

MARIA DALMIN RANTISA
115 198205252006041013
ALFRIDUS S.DEHO,A.MD.KES
116
ANASTASIA YASINTA HAVIA 19870427 200904 2 002
117
VINSENSIUS JEBARUS 19700204 200212 1 006
19800618 200604 2038
118
BERGITA AMBUNG,A.MD,KEB
19690603 200112 2 002
119
MARGARETA RADANG
120 19751121 200212 1 005

GABRIEL MAKSI
19781020 200604 1 017
121
FRIDUS SUWARDIN,S.MD.KEP
122
STEFANIA S. PARUS A. MD 19800126 200903 2 011
123 198010122011011007
DANIEL DORANTE PANI, S.SI
124
ANDREAS SANGO ATE,A.MD 19810603 200903 1 007
125 19810809 2011012010

NUR SUWAIBAH, S.SI
126 198204032009022006
IRENE IPAN,A.MD
127
MATILDA BAGHONG A. MD 19820505 200903 2 014
128 19820821 200963 2 007

ANIK MASRUFATIN,A.MD
129 19821022 200903 2 006

ELISABETH A. JEMALI,A.MD
130
FRANSISKA H. NAUR,A.MD 19821127 2009032016
131
MARIA MOI,A.MD 19830206 200903 2 012
132
AMABILUS LASAN A. MD 19830313 200903 1 006
133
MARIA NDOI,A. MD 19830711 200903 2 013
134 198307132009032009
KUNIGUNDE MOI A. MD
135 19831010 200903 2 013

MARWIAH,A.MD
136 198312202009032012
ELSI NIRMA MINGSI,A.MD
137
ANTONIA H, JEDIA,A.MD 19840509 200903 2 010
138
YOHANA E. SERA,A.MD 19840803 200903 1 011
139
KORNELIA KONDI,AMK 19850220 200903 2 012
140 19850331 200903 2 011

PAULINA YASINTA,A.MD
141
WILIBRODUS EMO,A.MD 198505212009031003
142
YOHANA PURNAMA SARI,A.MD. 198505302009032000
143 19850914 200804 2 003

MARIA ALFONSIA SARIA, A.MD.KEP
144 19851102 200903 2 009

VIKTORIA AMAL GAMI,A.MD
145 19851204 200904 2 008

AFRADIANA KURNIAWATI JUPIR
146 19870125200903 2 007

CAROLINA S. HADA A. MD
147 19870128 200903 1 002

ADRIANUS HARUM,A.MD
148
MARIA S. MING,A.MD 19870210 200903 2 006
149 19870221 200903 2 003

MARIA K.V. JEMARUS,A.MD
150
MARIA CH.M. LAGA,A.MD 19870723 200903 2 009
151 198708052009032004
MARIANI MARTEN,A.MD
152 19871115 200903 2 004

NOVAYANTI RAGUADO,A.MD.KEP
153 19800206 200303 2 001

MARIA G. V. EDEL
154 19821124 200604 1002

HERIBERTUS PAUL,A.MD.KEP
155
ROSALIA SINUT, A.MD 19870713 201001 2 025
19760114 200903 1 002
156
DOROTEUS MANTUR,A.MD
157
FRANSISKA NAMUL, A.MD.KEP 19771123 201001 2 012
158 19780511 201001 2 021

NURJALILAH HAKIM , A.MD KEB
159 19790420 201001 2 013

ANGELINA MUNDE, A.MD.KEP
160 19800322 201001 2 016

RITA, A.MD.KEP
161 19801226 201001 1 015

PETRUS NAMPU,A.MD.KG
162
FLORA NDAWUNG, A.MD 19810803 201001 2 028
163
MARTINA DAGHE 19820303 201001 2 026
164
MARIA EVODIA MALVIA, A.MD KEB 19820529 201001 2 038
165
YUVENTUS SALFUS, A.MD 19820627 201001 1 023
166
HENDRIKA D. SALEM, A.MD .FAR 198210062010012000
167
VALERIA YEFRI,A.MD 19821208 200903 2 015
168
GENOVEVA NDESE,A.MD.KG 19830103 201001 2 035
169
ALFERTIKA JAJA, A.MD.KEP 19830107 201001 2 025
170
FORTENSIUS F. MOSTES, A.MD KEP 19830222 201001 1 024
171 19830623 201001 2 042

EDELTRUDIS Y. SAIMAN, A.MD KEP
172 19830628 201001 2 027

FLORENTINA DADAS, A.MD.KEP
173
MARTA ROSALIA SURYANI, A.MD KEB 19830729 201001 2 033
174 19830508 200903 1 012

AGUSTINUS NALUT,A.MD
175 19830906 201001 2 136

WAHYUNI UTAMI, A.MD KEP
176 19830909201001 2 043

ERMELINDA DINA, AMK
177
FATIMAH, A.MD 19831025 201001 2 027
178 19831114 201001 1 026

AGUSTINUS IBLATI, AMK
179
AVENTINUS GONSALES JAMIN, 19831129 201001 1 012
180
MARIA F. KANTUR, A.MD .FARM 19831212 201001 2 037
181
DORFINA YULIA GARDIS, A.MD KEP 19840107 201001 2 025
19840222 201001 2041
182
MARIANA SINARTI MINCI, A.MD KEP
183 19840808 201001 2 034

AGUSTINA P. NDOK, A.MD.KEP
184
PONSIANUS TEMBER, A.MD KEP 198409012010011021
185 198409022010012032
EMELINDA ABIA, AMK
186
ELISABET D. MELDIS,A.MD 19840916 200903 2 016
187 19840916 201001 1 022

EFRIANUS JEHALUT, A.MD KEP
188 19850307 201001 2 028

FRANSISKA M. DAJANG, A.MD KEP
189
CHRISTINAWATY E. NDAE, A.MD 19850313 201001 2 035
190 19850430 201001 1 020

YOVINIANUS VENDI, A.MD KEP
191 19850430 201001 2 032

AGNES IWAS R.P.LANDOMARI,
192 19850514 201001 2 043

YUSTINA ENDA AMBUR, A.MD KEP
19850523 201001 2033
193
BERGITA NAWU, A.MD KEP
194 198506082010012048
EMILIA RIMIK, A.MD
195
MARIA GETRULDA ASALAM,A.MD.K 19850617 201001 2 040
196
FRANSISKA E. SOVERDI, A.MD KEB 19850621 201001 2 033
197 198507292010012026
DOMINIKUS JUMA, A.MD KEP
198
SABINUS DODI IKUT, A.MD KEP 19850731 201001 1 021
199
BENEDIKTUS ONGGOT, A.MD KEP 19850814 201001 1 019
200
YASINTA SADA BATE, A.MD.KEP 198512162010012044
201
MARIA HERLINA GALUT, A.MD KEP 19851229 201001 2 027
202
BENEDIKTUS BARUT, A.MD KEP 19860209 201001 1 019
203 19860220201001 2 032

MARIA G. MERLINA SATU, A.MD KEP
204
KILIAN JUFRI, A.MD KEP 19860226 201001 1 020
205 19860313 201001 2 039

MATILDA F. TILCE, A.MD KEP
19860414 201001 2 034
206
EMILIA ERNI, A.MD
207 19860428 201001 2 032
HILDA L. MANUR, A.MD KEP
208
SERLIN N. ENDENG, A.MD FARM 198605282010012000
209 19860603 201001 2 032

YASINTA E. RANGKANG, A.MD KEP
210
TERESIA STEFANI ARIM, A.MD.KEP 198606132010012048
211
PRISKA WING BIN, A.MD 19860723 201001 2 043
212 19860724 201001 2 042

MARIA SUMIYANTI AZI, A.MD KEP
213 19860828 201001 2 041

ROSLINDA DAIMAN, A.MD.KEP
214 19860923 201001 2 028

KAROLINA AWANG, A.MD.KEP
215 19861010 201001 1 023

EFRAMUS RICI SANATALEN, A.MD
216 198610292010012016
ROSALIA DALIMA SAINA JEMADU
217 19870102 201001 2 036

APOLONIA L JAIBA, A.MD KEP
218
BENEDICTA SELVIANA NONA, 19870104 201001 2 023
219 198702062010012028
BENEDIKTA K. N. DJEHATU, A.MD
220 19870208 201001 2 025

MARIA E.JEHAMA, A.MD.KEP
221 19870215 201001 2 023
YOFITA SURYANTI, AMK
222
TERESIA ROJATI SARMAN, A.MD 198706092010012034
223
GUSTIANA K. KANDI, A.MD.KEP 19870807 201001 2 037
224 19870813 201001 2 016

AGUSTINA JEMAT, A.MD.KEP
225 19871119 201001 2 023

AGNESTIA IRAN, A.MD.KEP
226
MARIA GORETI S. GAGE, A.MD.KEP 19871202 201001 2 017
227
ERWINDA MANTILA PURNAMA, A.MD KEP 19880204 201001 2 023
228
LILYANI A.JEMARI, A.MD.KEP 19880412 201001 2 014
229
MARIASNA SONETA PAKUR, A.MD.KEP 19880604 201001 2 015
230
YOHANA E. TANGGAL, A.MD 19880714 201001 2 013
231 19890329200903 2 001

ANASTASIA LINDI,A.MD
232
MARIA KURNIAWATI NIDA, A.MD.KEP 19890409 201001 2 005
233 19780417 201001 1 021

YEREMIAS GUNTUR, A.MD KEP
234 19820804 201001 1 021

YOHANES S.P KASI, A.MD KEP
235
ELFIRA SERI, A.MD.KEP 19850719 201001 2 035
236 19860309 201001 2 031

WILHELMINA NGINGGU, A.MD KEP
237 198604032010011019
FRANSISKUS GABRIEL GAWUS, A.MD
238
KAROLUS L.W. BANAR, A.MD 19860603201001 1 024
239 19860806 201101 2 0 17

ELVIRA SAINA KEON, A.Md.Keb
240 198609032010011012
NATANAEL MARIANTO DAPUTRA,
241 19870607 201001 2 039

EMILIANA MARIA JENIA, A.MD.KEP
242 19870715201001 1 010

BONEVANTURA K. TANJA, A.MD KEP
243
YOSEFINA D. NUSANTI, A.MD KEP 19871127 201001 2 023
244 19880611201001 2 022

SERLIYANTI AMBUN, A.MD KEP
245
ADRIANUS CEN, A.MD 19840313 201001 1 021
246
FATIMA NURTING.A.MD 19771216 200604 2 019
247
IRENE JENITATI 19800225 200604 2 016
248 19820709 200604 2 026

ANATALIA TEME,A.MD.GIZ
249 19811206 200903 2 007
TIYANTI SRI HARTATI,A.MD
250
EFLINA JENAI,A.MD 19830323 200903 2 020
251 19870120 200903 2 006

GRADIANA SASTRI,A.MD
252 19840626 201001 1 032

YOHANES JEMADI, A.MD
253 19860630 201001 2 037

FRANSISKA NAJU ,A.MD
254
PETRONELA H. SELAMAT,A.MD 19860906 200903 2 008
255 19870510 201001 2 042

MARIANA M. NINGSIH,A.MD.GZ
256
MARIA FATIMAH SAY ,S.GZ 19890825201403 2 002
257
RAHMIYATI RAHIM 19910222 201503 2 010
258 19730128 200112 1 002

LAURENS SANTUS
259 19840716 201001 2 047

MARIA K. WELA, A.MD KEP
260
SIRENA MERDEKAWATI SUN ,S.Farm 19870816 201403 2 003
261 196712121990031014
ADOLFUS WANGI ,A.Md.Kep
262
MARIA DIANA DURBIN,A.MD.KEP 198212072005012010
263
WALDETRUDIS M. SUWARNI, A.MD 198212202006042014
264
BURHANUS NENDONG, S.KEP 198307032010011038
265
YUSTINUS NIRON,A.MD 19840524 200903 1 005
266
MARIA Y.W.CARVALLO, S.KM ,S.KM 198509022010012045
267
RIKARDUS NAJONG, S.KEP 198904092011011006
268
TERESIA BEDARIA,A.MD.KG 19840328 201001 2 036
269
NATALIA P. INDRANINGSIH, A.MD 19871225 201001 2 029
270
VENANSIA HERLINA JENI.S.KEP.NES 198804092012122001
271
KONSTASIA ANITA STEPI 198901292014032004
272
MARIA ROSA WEA CO'O,STr,Keb 197408302005012005
273
YULIANA HERVINA NAWU 19860601 201101 2 018
274 19831106 200501 2 012

YENI JULAIHA JANGO
275
MELKI PAREMME, S.KM 198705162011011010
276
MARIANUS ARDIANUS M.MBATA ,SKM 198502112011011000
277
IRENE ROSARI, S.KM 198504032011012009
278 19720225 199403 1 006

ELBERTUS ROY MASKUR
279 19660618 200604 2 011

KRISTINA TIMUR
280
MARIA ERMELINDA RENDANG 19750821 200312 2 004
281
DIANA NIRU 19730806 200604 2 018
282
VERIDIANA E. JAYA 19770922 200604 2 024
283 197602292006042014
ANJELINA GONSELI
284 19741102 200604 2 019

MELKIA ASAL
285
AGUSTINUS SUBANTAR 196710261990031007
286 19690404 200604 1 018

KASMIR NADUT
287 19820117 200212 2 003

MARIA EPILIA NIAT
288
LODOVIKUS JEHARUS 19830503 200312 1 003
289
AMBROSIA RAHA 19841207 200604 2 011
290 19820519 200604 2 021

MERLIN ENO
291
IRMINA JEMINA 19830115 200604 2 014
292 19850516 200604 2 009

PEREGRINA HARIATI KURNIA
293 19811113 200501 2 016

SISILIA MENSI
294 19750421 200501 1 007

MARSELUS RONI
295 19670903 200212 1 033

ANSELMUS TUNGAL
296 19780416 201101 2 005

MARTINA NGINDANG, A.MDK
297
MARSELINA CONSINTHA EMBU, A.MKL 19801117 201101 2 006
298
APPOLONIANUS RASMON,A.MD 198207232009031009
299
WILHELMINA J. MUKU, A.MD KEP 19821003 201001 2 039
300
BONEVANTURA YUVEN, A.MD ] 19830715 201001 1 047
301
SISILIA YASINTA MINA, A.MD.KL 19830822 201101 2 011
302
NURMAYA, A.MD KEP 198511022010012033
303
TEDY KARSON, A.MD.KEP 19860719 201101 1 008
304
DIONISIUS CANGGUR, A.MD FARM 19870501 201001 1 011
305
REGINA MALO 19740128 200212 2 005
306
HERONIMA PAULA LUSIANA 19780218 200604 2 022
307
ROSA ERLIN LOI DAA.A.MD.KG 19780219 201212 2 002
308 19690527 200212 1 005

MARTINUS JAMUN
309
KRISTINA ANDA, A.MD.KEP 19820604 201101 2 009
310
LUSIA IVONE MANUBELU, A.MD.KEP 198311 17201101 2 011
311 19841015 201001 2 021

MUNTA SIFATUS SYAHRIA, A.MD.KEP
312
DAMIANUS KA'ANG, A.MD.GZ 198508052011011014
19860111 201101 2 016
313
HELMIDA LUTIFAN, A.MD.GZ
314
MARIA F. L. GASANG, A.MDK 19860329 201101 2 014
315
BLANDINA ROSNA RAJO, A.MD.KEP 19871129 201101 2 022
316
YOVITA KURNIAWATI, A.MD.KEP 198804242011012026
317
RENILDIS MOJENG, A.MD.KEP 19880831 201101 2 013
318
LUSIA ASTUTI JAINDA, A.MD.FARM 19891026 201101 2 010
319
ELYSABETH MULYATI, A.MD.KEP 19830123 201101 2 009
320 19890122201101 2 013

VINSENSIA TUTONUBA NGGUNU,
321 19860308 200804 2002

FRANSISKA S. BLAANG, A.MD. KL
322
THERESIA EPI,A.MD 198203082009032013
323
GREGORIUS R. ABOR,A.MD 198410102009031008
324
YOVITA FEBRY LUSI, S.KEP 198602222011012019
325 19851120 201101 1 008

OKTAVIANUS R. GANAR, S.KEP
326
DIETRICIUS TALIMAN 198607012010011016
327
ADRIANUS PORI ,A.MD 198107182010011029
328
WIWIT H. GANAR, S.KEP 198204302012121004
329
MARIA FIANNEY ANITA ,A.Md 198608042010012033
330
HERMINA LINODEN 198611052010012022
331
KRISTOFORUS SIONG, A.MD 198707232010011011
332
VINSENSIA TIWU MEZE ,S.kep.Ners 198805142014032001
333
FREDERIKUS HENDRA MUTU 19880727201403 1 005
334
ESTIANA NENSI HAMBU ,S.Si 198912162014032003
335
ATANESIA INDRIYANI HUMAN, 199105022015032007
336
YASNI DAIMAN SAIK, A.MD.KEP 19860920 201001 2 024
337
dr, dr. PUTRI ARIHTALIA BR PURBA 198703272017042007
338 197707132003122012
MARIA YASINTA
339 197311282005011009
FABIANUS YAN SUPANDI
340 19790803 200212 2 002

EMILIA SUSIANA SINTA
341
SUSANA E. NASSA, A.MD FARM 19830819 201001 2 031
342 19790127 201905 1 001

dr, DEDEK HANDRIYANI ,S.Ked
343 198008132019032010
AGUSTINA SELVIDAYANI,
344 19911226201903 2 006

FANNIE NDAMA, S.Farm.Apt
345
PAULUS LALONG PARONG ,S.Farm 19890401 202012 1 007
346
BERNADETA NORCE ENDANG 198602072014032003
347
ELIZA KUSUMANIGTYAS.S.KEP 19870416 201212 2 004
348 198812102014032005
CHRISTINA NATALIA CARVALLO
349 19890317 201403 2 003

PATRISIA EFRIN JEHUNI
350
YOHANES B. GANTUR.S.KEP 19890829 201212 1 001
351
ALDETEUS SAFRINO WYDIAWAN 199009242014031001
352 19901005 201503 2 007

SELVIANA Y.W. NGABUT,S.KEP.Ners
353
MARIANA FEBRIANI BASARI, 19890203 201903 2 002
354 19890523201903 2 005

MARIA SKOLASTIKA WIDYAWATI GANGGUR,S.
355
MARIA AGNESTASIA GELANG, 19930207 201903 2 008
356
YUSTINA H.B. MASMUR 19720421 200604 2 023
357
WITHA SOFIA 19720630 200701 2 018
358 19780605 200604 2 923

SOFIA ELSI PAMPO
359 19770520 200701 2 021

YULIANA NINA
360
HELENA D.W. SETIATI 19780818 200604 2 034
361
SABINA NURIA 19750822 200604 2 022
362 19730716 200212 2 001

SILVIANA NURCE
363 197111072007012016
FELINTIA SUN
364
HERLIA Y. BAHARUN 19790630200712021
365 19770426 200701 2 019

ERNESTIN MBALUR
366
MARGARETA LULUT 19770222 200604 2 019
367
THERESIA TURSIANA 19760814 200701 2 024
368
ELISABETH PROVITA MURNI 19691113 200701 2 024
369
ERNESTINA SOO 19791224 200701 2 013
370
LIDIA GUTERRES 19760110 200701 2 027
371
VENITIA ANITA TUA ,A.Md,Keb 19851231 200903 2 011
372 19861117 200903 1 002

PAULUS SUDARTO,A. MD
373 19660314 200604 1 012

KALIKSTUS BANIR
374 19860624 201001 2 032

SELVIANA LELY JELAUT
375
ELVIYONSA AVILA HAYATI, A.MD 19870503 201001 2 031
376 19781001201101 2 008

TRESIA LANDANG, A.MK
377
YULIANA K. MARWATI, A.MK 19800125 201101 2 007
378
NOVISIA NONA, A.Md.Kep 198108222010012013
379 19831127 201101 2 015

MARIA KARLES LALUNG, A.MD.KG
380 19850710 201001 1 026

YULIUS NESA
381
MELKYADES DE S.S. JUMA, A.MD 19860518 201001 1 020
382
RATNA S. NITA, A.MD KEP 19860628 201001 2 038
383
ALEKSIUS RANO, A.MD.KEP 19860911 201101 1 011
384 19861209 201101 2 016

ELISABETH MURNI, A.MD.GZ
385 19871130 201101 2 020

LIDWINA UNAL, A.MD.KEP
386 19880405 2011012 012

KRISTINA ASTANINA,AMK
387
AGNESTINA JUINDA, A.MD.KEP 19881119 201101 2 017
388 19760913 200604 1 009

EVENSIUS MUGAR
389
YULIANUS LEMOGEDAS MEO, 19860107 201001 1 011
390 198804122011011 010

BILTASIUS YANSENS NGGORONG,
19780620 201001 1 022
391
XAVERIUS SADI, A.MD KEP
392 19820603 201001 2 039

YUSTINA SITI
393 19830409 2011011 006

PASKALIS DANDUNG, A.MK
394 19831120 201101 1 005

YOHANES PUTRA DA ALDO SAMBI,
395
BENEDIKTA RUWEL, A.MD.KL 19840711 201103 2 013
19841201 201001 1 032
396
DIONISIUS ARMAN, A.MD KEP
397 19850114 201212 2 003

YUSTINA FRIKA DHIKA.A.MD.KEB
398
EVELINA BERLINCE WEKA,A.MD.KEP 19850904 201212 2 003
399 19850929 201001 2 046

RAFAELA VINENSI
400
VINSENSIUS LAHUR, AMD.KG 198510052011011010
401
DORCE YONO,A.MD.KEP 198205292010012003
402 19750219 200701 2 019

YOANA SAMUL
403 19880401 201212 2 002
VENANSIA A.S.GARAT,A.MD.KEB
404 19880808 201212 2 002

MARIA T.RAHAYU,A.MD.KEP
405 19880812 201212 2 002

SUSANA SULASTRI PRIMADEWI,A.MD.KEB
406
ROSITA M. R. LEWAR, A.MD. KEB 198809052012122003
407
SESILIA E.Y.DIRU,A.MD.KEB 19881125 201212 2 002
408 19890103 201001 1 004

FULLGENCIUS T.EMELGHI,
409
AGUSTINA SUSMULYATI JAPEN, AMD. 19890215 201101 2 004
410 19890725201001 2 003

IRVANSENSIA D. MUTIARA, A.MD
411 198908152012122002
MARIA OSIANA PASING,A.MD.KEB
19891026 201101 2 001
412
FLORINTIANI PANDUR, A.MK
413
ROSELINA F.OGOT,A.MD.KEB 199001172012122001
414
YOHANA DIUT ENEK,A.MD.KEB 19900202 2012122004
415 19900713 201212 2 001

AYULINA I.JADE,A.MD.KEP
416 19900722 201212 2 002

DEWI YUNI NURSANTI.A.MD.KEB
417
SULASTRI LAURENSIA HIMA 19900810 201212 2 002
418 19910123 201212 2 002

EMERENSIANA JEDADU,A.MD.KEP
419 199103032012122002
KAMELIA PRIMA CARDAYO,A.MD.KEB
420 19771206 200604 1 018

FLORIANUS MENSI
421
YOHANES GONSAGA PANAS, A.MD.KEP 19830308 201001 1 017
422
SIMPELSIUS BEROS, A.MD.KEP 19840823 201101 1 016
423
MAKSIMUS I. PANTANG, A.MD.KEP 19850528 201001 1 021
424 198509012010011016
MAXIMUS MANSYUR, A.MD KEP
425
YOHANA G.ROBINA.MD.KEB 19871109 201212 2 003
426
SENSIANA SUHARNI EMBU ,A.Md.Kep 19801117 201101 2 006
427
MARIA M.JEHIMUN,A.MD.KEP 19881124 201212 2 002
428
VERONIKA NARNYO,A.MD.KG 19890709 201212 2 001
429
YOHANA SERLIN TURUT ,A.Md.Kep 19900407 201403 2 002
430 19900523 201212 2 001

MARIA F.SUKARDI.A.MD.KEB
431 19900703 201503 2 001
HELIODOR RERI SORO,A.MD.KEB
432 19900811 201403 2 005

SUSIANA K..ROSBA MANGGAS
433 199012172014032002
YOLANDA UMA KETUNG ,A.Md.Kep
434 199101272014032002
KAROLINA ANGELINA MOGHI
435
KRISTINA DWIANTI BON ,A.Md.Kep 19911005 201403 2 003
436
S.Kep.,Ns, TARSISIUS IWAN PRATAMA NUGU199208152022031004
437
SRI RACHMAWATI BAY ,A.Md.Kep 198705052011012019
438 19910603 201403 2 002

KLOTILDA ELFIANI SUKANTO
439
LELIANA KEKO ,A.Md.Kep 19880113 201403 2 002
440
YONANSIUS MADU 1991072520150310 001
441 19920724 201503 2 005

TELIMIYATI DAIMUN,Amd.Kep
442
YUSTINA RIN 19660423 198703 2 007
443 19660122 199103 2 006

ROFINA NIDAS
444
LILIS AMPANG ALO 197806182006042026
445
MARSELINUS R. NANDI,A.MD 198503272009031010
446
YOSEFINA IMELDA MORU ATY, A.MD 19811117 200903 2 010
447
HENDRIKUS PAULUS JEHAMA, A.MD 198002062011011005
448
TOBIAS NENDO, A.MD.KEP 198410172010011025
449 19860929 200903 2 012

HILDEGARDIS TIMUN
450
MARIA KURNIATI WAGUT, A.MD 198708082010012035
451
WENDELINUS E. NAI, A.MD 198910202011011000
452
FILOMENA AIRIN NGAJANG,A.MD.KG 19870729 201212 2 004
453
CAROLINA OJONG,A.MD.KEB 19881028 201212 2 002
454
S.Kep,.Ns, MARIA YENI SARNIYATI 198701092022032005
455
S.Kep, Ns, YOHANA FIFI ANIS 19870624 202203 2 002
456
S.Kep.,Ns, ERMELINDA WELYATI 19891023202203 2007
457 19900107 202203 2 008

S.Kep., Ns, YOLANITA OKTAVIA RAHMAT
458
S.Farm, WALTER ROBIJALFAL 199004112022031009
459
S.Kep.,Ns., MARIA GORETI 199007262022032008
460 199111272022032013
S.Kep, FERGILIANA CECILIA PRISILIA JENAT
461
S. FARM, DOMINIKA DOS PASOS ODOS 19920506 202203 2 011
462
S. Kep., Ns, NURUL AINUN NAIM 19920515 202203 2 008
463
S.Farm, FRANSISKA C. BALATANDO 199206132022032008
464 19940626 202203 2 014

S. FARM, FRANSISCA YUNITA DWIWULANDAR
465
S. kep, FERDINANDUS RIAN 19941128 202203 1 008
466
S.Kep.,Ns, EFARISTA SYUL KURNIATI 199607152022032017
467
WIGBERTUS DAI PUNANG ,S.Kes 19860523 202012 1 002
468
LOUISA ANGGRYANI NAI ,S.Kep 19870124 202012 2 002
469
AGUSTINA OLIVIANIKIANGSI ,S.Kep 19870827 202012 2 005
470
MARIUS HENDRIKUS HATING ,S.Gz 19880303 202012 1 007
471
YOHANA SALVANTIS ,S.Kep 199001142020122007
472 19900506 202012 2 008

KLAUDIA KOTA ,S.Kep
473 19900619 202012 1 004
ROMUALDUS EVENSIS TANUR ,S.Kes
474 19910807 202012 2 001

MARIA AGUSTIN SWANDAYANI ,S.Kes
475
SUSANA CLAUDIA CRISTINA YONGSI 19920128 202012 2 006
476 19920513 202012 1 003

SERVASIUS SUNARTO ,S.Kep
477 198208242017042002
MARIA KAROLINA LAWE, A.Md.Keb
478 19870518 201704 2 005

MARIA AVELINA YULITA W. TANDA,
479 19900203 201704 2 001

MELANIA KARDIN MAKO,A.Md.Keb
480
ROSLIN SAN FONA, A.Md.Keb ,A.Md 198405292017042002
19860701 201704 2 004
481
JULIA LETITSIA TARIHORAN,
482
YUSTINA SANTIMAN, A.Md.Keb 19860824 201704 2 002
483 19870909 201704 2 002

NIRA NIKA, A.Md.Keb ,A.MD
484
PETRONELA BANSELE, A.Md.Keb 19870915201704 2 004
485 19880204 201704 2 004

FILOMENA DHAMBO, A.Md.Keb ,A.MD
19880710 201704 2 002
486
FRANSISKA JELITA, A.Md.Keb
487 19880719 201704 2 003
MAKRINA NGOEL, A.Md.Keb ,A.MD
488
SALESTINA BERTINA DOMO, 19880910 201704 2 003
489
AQUINA HELCINA MALI, A.Md.Keb 19890125201704 2 001
490 19890726 201704 2 005

ANNA MARIA GORETI NAMPUT,
491
MARIA OVIAN DUPA, A.Md.Keb 19890929 201704 2 002
492
MARIA MENDEL SULASTRI JAPUNG, 19891027 201704 2 002
493 19891130 201704 2 001

SUSANA KURNIAWATI JERANO,
494
VILNON BALDWIN YESA PERAS,A.Md.Keb 19900322 201704 2 002
495 19900410 201704 2 003

HILDA ELSI PALUS, A.Md.Keb
496
MELTIANA NURHAYATI IGANG, 19900502 201704 2 005
497 19900625 201704 2 003

LUSIANA JUMIATRY PIANG,
498 19901218 201704 2 001

NUR SALIYANTI N
499
MARIA ANITA NAWU, A.Md.Keb 19860601 201101 2 018
500
YULIANA OSNA TANGKUR, A.Md.Keb 19911220 201704 2 001
501
AGNES TARUK ALLO, A.Md.Keb 19930103201704 2 001
502
MARIA ODILIA GELANG ,A.Md.Far 199202072014032002
503 19930705 201503 2 004

YULIANA IRWANTI ,A.Md.Keb
504
ROSIANA NDELANG 197701192006042009
505
DOMINIKUS SON 19670723 199103 1 006
506
HELENA MANIK SABAN, A.MD.GZ 198712212011012013
507 199604232020122011
MARIA FRANSISKA DINITRIE YAMIN
508 19870212 202203 1 004

S.KM, IGNASIUS HENRY SUHARDIN,
509
SE, SIMPLISIUS MARIO PUTRA 198703022022031000
510
SKM, PETRONELA NINUR 198806142022032005
511
S. KM, REINELDIS YOSEFINA AWI 19930716 202203 2 006
512 19820930 200604 1 014

VALENTINUS BURHAN
513 19750830 200903 2 003

YUDHIN KUSUMANINGSIH
514
NURIATI DIKING, A.Md.Keb ,A.MD 19870617201704 2 004
515
SOFIA SAINA, A.Md.Keb ,A.MD 198811042017042006
516 197308182006042015
MARSELINA RUDI SANSIA
517
IGNASIUS PORUS, A. MKG 19770606 201408 1 003
518 19841204 201212 2 003

RENSIANA ERNA
519
LIDIA MINA 197706052007012041
520
ARNOLDUS A. ANGGAT, A.MD 19840318 201101 1 015
521
ROSVITA PAULINA DEA, A.MD 19870327 201001 2 028
522 19890131 201001 1 001

YOHANSES S.H.JEBADU, A.MD KEP
523
MARIA M. M. NAMAR 198905292010012005
524 19890915 201001 1 001

INOFANSENSIUS WIKARSON
525
HERNITA VINI BALIKS,A.MD.KEB 19810216 201212 2 001
526
HERLINA NATALIA KADE ,A.Md.KG 198612202014032002
527
KRISTINA M.NDONDO,A.MD.KEB 19871025 201212 2 001
528 19880628 201403 2 003

MARSELA RATNA SARENG ,A.Md.Kep
529
MARIA EFRASIA GANU,A.MD.KEP 19881113 201503 2 004
530 19890417 201403 2 005

KONSITA MEGA WARNI ,A.Md.Kep
531 19891111 201403 2 004

MARTINA NOVA ,A.Md.Kep
19900226 201503 2 003
532
EFRIDA DUET, A.md.KG
533 19900712 201403 1 002

YOHANES HARDENI ,AMK
534 19900911 201403 2 004

HELENA YASINTA JAIMAN ,A.Md.Kep
535
RENIANA ENO ,A.Md.Keb 19780806 201905 2 001
536 19850917 201001 1 016

BELLARMINUS TAGUR, A.MD KEP
19880518 200903 2011
537
YULITA P. RADA
538
ANSELMUS DOGAS, A.MD KEP 19850528 201001 1 021
539 19870129 201403 1 002

YOSEP INOSENTIUS BAHY ,A.Md.KG
19890423 201403 2 001
540
GETRUDIS NOFITA FE ,A.Md.KG
541
TARSISIUS RAMLI, A.Md.Kep 19870728 201903 1 006
542 19891128 201903 1 003

MENOFELTUS DARMAN, A.Mk
543 19900220 201903 2 005
AFRIYANI SINCE NURMA, A.Md.Keb
544 199107162019032007
HILARIA MARIA NDAHUNG, A.Md.Kep
19920216 201903 2 008
545
YULIANA EUFROSIN SARCE, A.Md.K
546
METILDA KANTUR A.Md.Farm 19920315 201903 2 007
547
YOLANDA NURDIN, A.Md.Kep 19920617 201903 1 007
548
ROSA DA LIMA LIASPAR, A.Md.Keb 19920823 201903 2 007
549
YULITA BERNADA MENGE, A.Md.Keb 19930705 201903 2 010
550 19940326 201903 1 007

LUDGERUS RIKARDUS NGGUDI,
551
GAUDENSIA SASTRIANI NIJUNG, 19951013 201903 2 006
552 19910703201903 2007

ISABELA LANGUS, A.Md.Keb
553 19890120201903 2006

IVONNY JUNARIS AUW, A.Md.K
554
YASINTA AGUSTINA TUGA 19830315 201408 2 006
19740825 200801 1008
555
DAMASUS DAM
19750929 200901 1007
556
RAFAEL ANSEL DURA
557
SERFOLUS TAUFAN NYAMA 19780116 200901 1 006
558 197405142009031001
MARSIANUS DUARMAN
559
YOSEFUS TORAR 19760730 200903 1 003
560 198010302009032009
AMBROSIA RAISA
561 19890415 201001 2 008

ANASTASIA MARIANI MAHAT
562
STEFANUS BARSON SATUR, A.Md.T 199502142019031004
563
RAHAYU PAKUNG VERONIKA 197608142005012008
564
AGUSTINA SEUK ,A.MD 19820802 201704 2 006
565 19860430201705 2 001

ELVIARA IRA ,A.Md
566
AGNESIA ONITA RAE ,A.Md.G. 19890420 202012 2 006
567 19900410 202012 1 004

PASKALIS HERYANTO PATU
568
EPIYONARDI LEONSIUS PARERA 19900618 202012 1 003
569
EUSEBIUS TECAN RUDIN ,A.Md.Kep 19900802 202012 1 003
570
YUSTINA HERLINA MARYANI FATIMA 19910116 202012 2 003
571 19910119 202012 2 010
YANUARITA PRISKA HAMBUR
572
MARSELINUS SUMARLIN ,A.Md.Kep 19910520 202012 1 006
573 19910710 202012 2 006

ELFRIDA ERMENILDA ARIATMA
574 19911022 202012 2 008

ROSMIATI ,A.Md.Keb
575
EMANUELA TEGU ,A.Md.G. 19920119 202012 2 008
576 199205042020 01 2205

GEMMA GALGANISON MBIKUNG
577 19920802 202012 2 011

EUSEBIA VERCELLA VEDITRYX
578
KATARINA YOVITA SINTA ,A.Md.G. 19921125 202012 2 008
579
KRISTA VONI PURNAMA ,A.Md.Keb 19930604 202012 2 005
580
MARIA LUDVINA UTA ,A.Md 19940302 202012 2 009
581
YASINTA MINUT ,A.Md.Kep 19940719 202012 2 007
582
KRISTIANI PAX JUFILIA NDAHU 19940724 202012 2 005
583
BEATRIX KARUNIA ENDU ,A.Md.Keb 19950918 202012 2 008
584
MARIA MARGETA ERNESTA FALE, Amd.Keb 19960112 202012 2 009
585
MARGARETA SINDANG ,A.Md.Far 19960720202012 2 005
586
YOSEF STANISLAUS MENNA ,A.Md 19970319 202012 1 002
587
CHERLY ANITA SURYA JEWADUT 19980710 202012 1002
588 19980716 202012 2 002

AVELINA YOLANDA MOEDA DA SILVA
589 19990519 202012 2 002

ALWIAH ,A.Md.Far
590
KARSINI NIRMA BIAT ,A.Md.Keb 199201092020122009
591
MARIA IRMA DEWI ,A.Md 19920315 202012 2 010
592
EVARINTUS AMANDUS ZAKAT ,A.Md 199405312020121000
593 198103272012122004
SISILIA CELING
594
TIMOTIUS SURYANTO 197207122008011024
595
HERIBERTUS S. AKONG 19801010 200801 1 031
596
BERNADETHA SEPTY YUDISTA ,A.Md 19910922202012 2 010
597
AMK, MARIA SARINA GONSA 198607082022032002
598
A.Md.Keb, ANGELINA MARICE ERNA 19870910202203 2 005
599 19880325 202203 2 003
A. Md. Keb, SITI HAWA
600 19880728 202203 1 002

Amd.Kep, PAULUS HENDRA TOFIA
601 19890311 202203 2 005

A. Md. Kep, FIRMINA ESTRIANI JEHABA
602
A. Md. Kep, TRIFONIA RONELSA 198904162022032001
603
A.Md.Keb, RESTIANA ALAIN DELONA MARUT 198907052022032006
604
A.Md.Keb, YOHANA AGRISTA ESAWATI RAGA198908132022032008
605 19900129 202203 2 008

Amd. Keb, YULIANA ULFIANI DOMAL
606 199101152022032011
A. Md. Keb, YURDIANA FAT
607
A.Md.Ak, ALISIA SALINI DABUT 199106212022032011
608
A.Md.Keb, PRAKSEDIS JUHAMI 19910721 202203 2 008
609
A. Md. Keb, ERMIANA OLIVANIA JEPA 199111182022032005
610
A.Md.Keb., ELFRIDA AVILA 199310082022032012
611
A.Md.Keb, MARIA FRANSISKA SOLAMUS 199207142022032011
612
A.Md.Keb, FILOMENA CLOTILDA MIRNA 19920907 202203 2 008
613
Amd.Kep, YASINTA ONADI 199210252022032019
614
A. Md. Keb, MARIA FELISITAS FATIMA 199301142022032006
615
A.Md.Keb, BENEDIKTA ANDITHA FERNANDEZ199305052022032013
616 19930824 202203 2 013

Amd.keb, YASINTA INUS
19930929 202203 1 005
617
AMD.KEP, MIKAEL WARA
618
A.Md.Keb, TERESIA AVILA 199310082022032012
619
Amd.AK, OLYMPIAS MELSIANA MARSEPHY 19931217 202203 2 017
620 19940409 202203 2 008

A. Md. Keb, APRILIA SETIA WATI
621
A.Md.Keb, REGINA SERVINA ISA 19940909 202203 2 017
622
MARIA GALGANIA LADY YOYANI 199505042022032018
19950812 202203 2 010
623
A.Md. Keb, HILARIA DALIA GANU
624
A.Md.Keb, YUSTINA KURNIA DA BELA 199508302022032011
625
A.Md.Farm, GAUDENSIA NDIANG 199510142022032010
626
AMd. Keb, GENOVEVA JEMIMAT 19960103 202203 2 019
627
A.Md. Keb, EDELTRUDIS SURYATI JEMARUT 19960624 202203 2 019
628
A.Md.KL, YASINTA NOTIVIRGULA ENAS 19960911 202203 2 014
629
A. Md. Kes, MARIA IRNA JELAHUL 199610122022032012
630
A.Md.Keb, MARIA DIANA FIS 199710032022032013
631 199907272022032016
A.Md.Farm, STEVIE CLAUDIA INDRI TANIA
632
A. Md. Keb, LENSIANA NUSING 19930715 202203 2 008
633
FABIANUS LESONG 19790728 200901 1 006
DATA PEGAWAI
NIK NPWP Pegawai Alamat Pegawai
4 5 6
5308205903680001 41.953.869.9.924.000 BORONG
BORONG
BORONG
531901450879007 158389056924000 BORONG
BORONG
BORONG
BORONG
5319012209840001 16083224924000 BORONG
5319016412830001 15.991,048..8924.000 BORONG
5319050602730001 155687379924000 BORONG

BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319026008780001 15.667.147.1.924.000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319052806840002 160429999924000 BORONG
BORONG
BORONG
3
5319011909870003 160431151924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
1 1 022 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319016912850005 160832184924000 BORONG
BORONG
BORONG
5319012602680001 161863626924000 BORONG
BORONG
5319065404860004 160831293924000 BORONG

BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319066711870001 161207550924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319064707850003 16.543.5736-924.000 BORONG
5319040904890001 16.419.773.3-924.000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5306031102850002 155629447922000 BORONG

5319014304850321 721592913924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5310065112870004 45.229.961.3-435000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319021010840004 155688112924000 BORONG
BORONG
BORONG
5319060107860009 160832408924000 BORONG
BORONG
BORONG
BORONG
5319014211860002 164984981924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319054110780001 165433681924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319015301880001 743418642924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5319079307910001 911801702924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
5310116511920001 914320510924000 BORONG
BORONG
BORONG
5319025907940001 410509160924000 BORONG
BORONG
5319065809950003 160832267924000 BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
BORONG
DATA PEGAWAI
Pangkat/Golongan Jabatan Jenis Kelamin
7 8 9
PEMBINA UTAMA MUDA / IVC KADIS PEREMPUAN
PEMBINA UTAMA MUDA / IVC DOKTER PEREMPUAN
PEMBINA UTAMA MUDA / IVC DOKTER PEREMPUAN
PEMBINA TK.I / IVB DOKTER PEREMPUAN
PEMBINA TK.I / IVB STAF PEREMPUAN
PEMBINA / IVA KEPALA PUSKESMAS LAKI-LAKI
PEMBINA / IVA SEKRETARIS PEREMPUAN
PEMBINA / IVA KABID LAKI-LAKI

PEMBINA / IVA KABID LAKI-LAKI
PEMBINA / IVA STAF PEREMPUAN
PENATA TK.I / IIID KABID PEREMPUAN
PENATA TK.I / IIID KABID LAKI-LAKI
PENATA TK.I / IIID KASUBAG KEUANGAN PEREMPUAN
PENATA TK.I / IIID KASUBAG KEPEGAWAIAN LAKI-LAKI
PENATA TK.I / IIID DOKTER PEREMPUAN
PENATA TK.I / IIID DOKTER GIGI PEREMPUAN

PENATA TK.I / IIID KEPALA PUSKESMAS LAKI-LAKI
PENATA TK.I / IIID STAF PEREMPUAN
PENATA TK.I / IIID STAF LAKI-LAKI

PENATA TK.I / IIID KASIE PEREMPUAN
PENATA TK.I / IIID KASIE LAKI-LAKI
PENATA TK.I / IIID KASUABAG PDE LAKI-LAKI

PENATA / IIIC STAF PEREMPUAN
PENATA TK.I / IIID KEPALA PUSKESMAS PEREMPUAN




PENATA / IIIC KEPALA PUSKESMAS LAKI-LAKI







PENATA / IIIC STAF LAKI-LAKI


PENATA TK.I / IIID KAPUS LAKI-LAKI


PENATA / IIIC KASIE LAKI-LAKI
PENATA / IIIC KASIE LAKI-LAKI

PENATA / IIIC KASIE PEREMPUAN


PENATA MUDA TK.I / IIIB STAF PEREMPUAN

PENATA MUDA TK.I / IIIB STAF LAKI-LAKI

PENATA / IIIC DOKTER PEREMPUAN
PENATA MUDA TK.I / IIIB DOKTER LAKI-LAKI


PENATA MUDA / IIIA STAF PEREMPUAN


PENATA MUDA / IIIA STAF LAKI-LAKI







PENGATUR TK.I / IID STAF PEREMPUAN

PENGATUR TK.I / IID STAF LAKI-LAKI




PENGATUR / IIC STAF PEREMPUAN
PENGATUR / IIC STAF LAKI-LAKI





PENGATUR MUDA TK.I / IIB STAF LAKI-LAKI

Perubahan
Tambahan
Jumlah Masa Status Kenaikan Tunjangan
Status Gaji 13, 14
Anak Penghasilan Pegawai Gaji Berkala Struktural /
dan THR
Fungsional
10 12 13 14 15 16 17
TIDAK KAWIN 1 0112 YA PENUH YA
KAWIN 2 0112 YA PENUH TIDAK
KAWIN 2 0112 YA PENUH
PINDAH
KAWIN 2 0112 TIDAK TIDAK
KELUAR
PINDAH
KAWIN 2 0112 YA TIDAK
MASUK
PEGAWAI
TIDAK KAWIN 0 0112 TIDAK TIDAK
BARU

TIDAK KAWIN 0 0112 YA PENUH TIDAK


















TIDAK KAWIN 0112 YA PENUH TIDAK



























DATA GAJI 1 (SATU) BULAN
Bulan Mulai
Tunjangan Penghasilan tetap
Perubahan Tunjangan
Gaji Pokok Struktural / yang terpisah dari
KGB / Khusus
Fungsional pembayaran gaji
Tunjangan
18 19 20 21 22
-
4,949,400 2,025,000
-
4,372,000 1,200,000
3,862,000 1,200,000
-
3,822,000 1,200,000
-
3,705,300 1,200,000
-
4,066,500 850,000
-
3,822,000 850,000
-
3,822,000 850,000
-
3,666,900 1,260,000
-
4,416,700 980,000
-
3,666,900 980,000
-
3,666,900 1,200,000
-
3,666,900 850,000
-
3,666,900 850,000
-
3,666,900 600,000
-
3,666,900 190,000
-
4,108,100 980,000
-
3,982,600 980,000
-
3,743,100 540,000
-
3,518,100 540,000
-
3,410,600 750,000
-
3,306,500 750,000
-
3,306,500 750,000
-
3,306,500 750,000
-
3,628,900 600,000
-
3,628,900 600,000
-
3,518,100 600,000
-
3,518,100 600,000
-
3,518,100 600,000
-
3,518,100 600,000
-
3,518,100 600,000
-
3,410,600 600,000
-
3,410,600 600,000
-
3,410,600 600,000
-
3,410,600 600,000
-
3,410,600 600,000
-
3,410,600 600,000
-
3,306,500 600,000
-
3,861,000 540,000
-
3,743,100 540,000
-
3,628,900 540,000
-
3,518,100 540,000
-
3,518,100 540,000
-
3,518,100 540,000
-
3,518,100 540,000
-
4,650,600 500,000
-
4,508,600 500,000
-
4,508,600 500,000
-
4,508,600 500,000
-
4,508,600 500,000
-
4,370,900 500,000
-
4,237,500 500,000
-
4,237,500 500,000
-
4,237,500 500,000
-
4,237,500 500,000
-
4,237,500 500,000
-
4,237,500 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
4,108,100 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,982,600 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,861,000 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,743,100 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,628,900 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,518,100 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,410,600 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,306,500 500,000
-
3,205,500 500,000
-
3,743,100 495,000
-
3,628,900 495,000
-
3,628,900 495,000
-
3,518,100 495,000
-
3,518,100 495,000
-
3,518,100 495,000
-
3,410,600 495,000
-
3,410,600 495,000
-
3,410,600 495,000
-
3,410,600 495,000
-
3,306,500 495,000
-
3,205,500 495,000
-
3,861,000 440,000
-
3,410,600 265,000
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3,306,500 265,000
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4,508,600 185,000
-
3,743,100 185,000
-
3,518,100 185,000
-
3,518,100 185,000
-
3,518,100 185,000
-
3,518,100 185,000
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3,518,100 185,000
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3,410,600 185,000
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3,410,600 185,000
-
3,410,600 185,000
-
3,306,500 185,000
-
3,704,300 600,000
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3,375,300 600,000
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3,272,200 600,000
-
3,375,300 540,000
-
3,272,200 540,000
-
3,272,200 540,000
-
4,065,500 500,000
-
4,065,500 500,000
-
3,941,400 500,000
-
3,941,400 500,000
-
3,821,000 500,000
-
3,704,300 500,000
-
3,591,200 500,000
-
3,481,600 500,000
-
3,481,600 500,000
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3,481,600 500,000
-
3,481,600 500,000
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3,481,600 500,000
-
3,481,600 500,000
-
3,375,300 500,000
-
3,375,300 500,000
-
3,375,300 500,000
-
3,375,300 500,000
-
3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
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3,272,200 500,000
-
3,272,200 500,000
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3,272,200 500,000
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3,941,400 265,000
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3,821,000 265,000
-
3,481,600 265,000
-
3,375,300 265,000
-
3,272,200 265,000
-
3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
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3,272,200 265,000
-
3,172,300 265,000
-
3,172,300 265,000
-
3,375,300 185,000
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3,375,300 185,000
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3,375,300 185,000
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3,375,300 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,272,200 185,000
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3,172,300 185,000
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3,172,300 185,000
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3,172,300 185,000
-
3,172,300 185,000
-
3,075,500 0
-
3,075,500 0
-
3,445,500 500,000
-
3,238,300 500,000
-
3,043,600 500,000
-
3,139,400 325,000
-
2,950,600 325,000
-
2,860,500 325,000
-
2,860,500 325,000
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2,773,200 325,000
-
3,043,600 300,000
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3,043,600 300,000
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3,043,600 300,000
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3,043,600 300,000
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3,043,600 300,000
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3,043,600 300,000
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3,043,600 300,000
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2,860,500 300,000
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2,860,500 300,000
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2,773,200 300,000
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3,781,400 265,000
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3,781,400 265,000
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3,665,900 265,000
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3,665,900 265,000
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3,665,900 265,000
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3,554,000 265,000
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3,554,000 265,000
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3,340,300 265,000
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3,340,300 265,000
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3,340,300 265,000
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3,340,300 265,000
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3,238,300 265,000
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3,238,300 265,000
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3,238,300 265,000
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3,238,300 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,139,400 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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3,043,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,950,600 265,000
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2,860,500 265,000
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2,950,600 242,000
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2,950,600 240,000
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2,860,500 240,000
-
2,860,500 240,000
-
4,280,800 0
-
4,023,300 185,000
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3,340,300
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3,238,300 185,000
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3,139,400 185,000
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3,139,400 185,000
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3,139,400 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,688,500 185,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,660,700 300,000
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2,920,100 0
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2,660,700 185,000
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2,579,400 185,000
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3,074,700 265,000
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3,171,500 240,000
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3,074,700 240,000
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2,980,800 240,000
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2,889,800 240,000
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2,889,800 240,000
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2,552,700 240,000
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2,552,700 240,000
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2,552,700 240,000
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2,552,700 240,000
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2,552,700 240,000
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2,552,700 240,000
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2,474,700 240,000
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2,980,800 220,000
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3,074,700 180,000
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3,074,700 180,000
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3,074,700 180,000
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3,074,700 180,000
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3,074,700 180,000
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3,074,700 180,000
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2,801,500 180,000
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2,552,700 180,000
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2,772,500 240,000
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2,687,800 240,000
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2,374,300 240,000
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2,374,300 240,000
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2,301,800 240,000
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-
2,949,900 180,000
2,772,500 180,000
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2,687,800 180,000
2,374,300 180,000
2,301,800 180,000
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2,301,800 180,000
2,301,800 180,000
2,301,800 180,000
2,301,800 180,000
2,301,800 180,000
2,301,800 180,000
2,743,800 180,000
2,036,562,000 238,117,000
2,036,562,000 238,117,000
0 0
KENAIKAN GAJI BERKALA DAN KHUSUS PINDAH MASUK (DALAM
PENGHASILAN YANG DIKENAK
TUNJANGAN STRUKTURAL / HAL BENDAHARA PEMBAYAR
SERTIFIKASI; HONOR
FUNGSIONAL BERBEDA)
Nilai Kenaikan Penghasilan Neto PPh Pasal 21

Nilai Kenaikan
Tunjangan (selisih (nomor 15 dari terutang (nomor PENGHASILAN
KGB (selisih dari
dari Tunjangan 1721 A2 22 dari 1721 A2 KOTOR / BRUTO
gaji pokok lama)
lama) bendahara lama) bendahara lama)
23 24 25 26 27
35,000,000
35,000,000
35,000,000
50,000,000
50,000,000
20,000,000
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50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
50,000,000
ILAN YANG DIKENAKAN PPH FINAL (UANG MAKAN;
SERTIFIKASI; HONOR) SELAMA 1 TAHUN
TARIF PPH FINAL
28 29
15% 5,250,000 JD-0 1 0
15% 5,250,000 K -1 2 0
15% 5,250,000
15% 7,500,000 K -1 2 0
15% 7,500,000 K -1 2 0
15% 3,000,000 TK-0 0 0
15% 7,500,000 K -1 0 0
15% 7,500,000 K -1 2 0
15% 7,500,000 K -1 2 0
15% 7,500,000 K -1 2 0
15% 7,500,000
15% 7,500,000
15% 7,500,000
15% 7,500,000
15% 7,500,000
15% 7,500,000
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 1 0
5% 2,500,000
5% 2,500,000 K -1 1 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 0 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -0 0 0
5% 2,500,000 K -1 0 0
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 TK-0 0 0
5% 2,500,000
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 1 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000 TK-0 0 0
5% 2,500,000
5% 2,500,000
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000 K -1 1 1
5% 2,500,000 TK-0 0 0
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000
5% 2,500,000 TK-0 0 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 K -0 2 0
5% 2,500,000 K -1 2 0
5% 2,500,000 TK-0 0 0
5% 2,500,000 TK-0 0 0
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
0% -
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
5% 2,500,000
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
0% -
area staples
BUKTI PEMOTONGAN PAJAK PENGHASILAN

PASAL 21 BAGI PEGAWAI NEGERI SIPIL ATAU FORMULIR 1721 - A2
ANGGOTA TENTARA NASIONAL INDONESIA Lembar ke-1 : untuk Penerima
ATAU ANGGOTA POLISI REPUBLIK INDONESIA Penghasilan
Lembar ke-2 : untuk Pemotong
ATAU PEJABAT NEGARA ATAU PENSIUNANNYA
MASA PEROLEHAN
KEMENTERIAN KEUANGAN RI PENGHASILAN [mm - mm]
DIREKTORAT JENDERAL PAJAK NOMOR : H.01 1 . 2 - 12 . 23 - 00000793 H.02 #N/A - #N/A
NAMA NPWP
INSTANSI/ DINAS KESEHATAN KABUPATEN MANGGARAI BENDAHAR
BADAN : H.03 A:
H.05
LAIN
NAMA BENDAHARA DINAS KESEHATAN KABUPATEN
: H.04 MANGGARAI TIMUR 00.139.629.0 - 924 . 000
BENDAHAR
A
A. IDENTITAS PENERIMA PENGHASILAN YANG DIPOTONG
A.0 JENIS
1. NPWP : 1 #N/A 6. A.07 ### LAKI-LAKI A.09 ### PEREMPUAN
KELAMIN :
2. NIP/ A.0
#N/A 7. NIK : A.09 #N/A
NRP : 2
3. NAMA : A.03#N/A 8. STATUS / JUMLAH TANGGUNGAN KELUARGA UNTUK PTKP

PANGKAT/
4. GOLONGAN
: A.04#N/A A.05 #N/A 3 #N/A
A.10
TK / #N/A
A.11
HB /
A.12
A.0 A.1
5. ALAMAT : 6 #N/A 9. NAMA JABATAN : #N/A
3
B. RINCIAN PENGHASILAN DAN PENGHITUNGAN PPh PASAL 21

URAIAN JUMLAH (Rp)
KODE OBJEK
: X 21-100-01 21-100-02
PAJAK
PENGHASILAN BRUTO :
1. GAJI POKOK/PENSIUN #N/A
2. TUNJANGAN ISTERI #N/A
3. TUNJANGAN ANAK #N/A
4. JUMLAH GAJI DAN TUNJANGAN KELUARGA (1 S.D. 3) #N/A
5. TUNJANGAN PERBAIKAN PENGHASILAN -
6. TUNJANGAN STRUKTURAL/FUNGSIONAL #N/A
7. TUNJANGAN BERAS #N/A
8. TUNJANGAN KHUSUS #N/A
9. TUNJANGAN LAIN-LAIN #N/A
PENGHASILAN TETAP DAN TERATUR LAINNYA YANG PEMBAYARANNYA TERPISAH DARI
10. #N/A
PEMBAYARAN GAJI
11. JUMLAH PENGHASILAN BRUTO (4 S.D. 10) #N/A
PENGURANGAN :
12. BIAYA JABATAN/ BIAYA PENSIUN #N/A
13. IURAN PENSIUN ATAU IURAN THT #N/A
14. JUMLAH PENGURANGAN (12 S.D 14) #N/A
PENGHITUNGAN PPh PASAL 21 :
15. JUMLAH PENGHASILAN NETO (11 - 14) #N/A
16. JUMLAH PENGHASILAN NETO MASA SEBELUMNYA #N/A
17. JUMLAH PENGHASILAN NETO UNTUK PENGHITUNGAN PPh PASAL 21 (SETAHUN/DISETAHUNKAN) #N/A
18. PENGHASILAN TIDAK KENA PAJAK (PTKP) #N/A
19. PENGHASILAN KENA PAJAK SETAHUN/DISETAHUNKAN (17 - 18) #N/A
20. PPh PASAL 21 ATAS PENGHASILAN KENA PAJAK SETAHUN/DISETAHUNKAN #N/A
21. PPh PASAL 21 YANG TELAH DIPOTONG MASA SEBELUMNYA #N/A

22. PPh PASAL 21 TERUTANG #N/A
23. PPh PASAL 21 YANG TELAH DIPOTONG DAN DILUNASI
23A. ATAS GAJI DAN TUNJANGAN #N/A
ATAS PENGHASILAN TETAP DAN TERATUR LAINNYA YANG PEMBAYARANNYA TERPISAH DARI
23B #N/A
PEMBAYARAN GAJI
DIPINDAHK
C. PEGAWAI TERSEBUT : C.01 ### C.02 ### PINDAHAN C.03 ### BARU C.04 ### PENSIUN
AN
D. TANDA TANGAN BENDAHARA
1. NPWP : D.01 00.139.629.0 - 924 . 000 4. TANGGAL & TANDA TANGAN
2. NAMA : D.02 FRANSISKA S. BLAANG D.04 31 - 01 - 2022

NIP/NRP [dd - mm - yyyy]
3. : D.03 19860308 200804 2 002
area staples
BUKTI PEMOTONGAN PAJAK

PENGHASILAN PASAL 21
(FINAL) FORMULIR 1721 - VII
Lembar ke-1 : untuk Penerima Penghasilan
Lembar ke-2 : untuk Pemotong
KEMENTERIAN KEUANGAN RI
DIREKTORAT JENDERAL PAJAK NOMOR : 1 . 4 - 12 . 16 - 00000793
H.01
A. IDENTITAS PENERIMA PENGHASILAN YANG DIPOTONG
1. NPWP : A.01 #N/A - #N/A . #N/A 2. NIK / NO. PASPOR : A.02 #N/A
2. NAMA : A.03 #N/A
3. ALAMAT : A.04 #N/A
B. PPh PASAL 21 YANG DIPOTONG

JUMLAH
TARIF PPh DIPOTONG
KODE OBJEK PAJAK PENGHASILAN BRUTO (%) (RP)
(Rp)
(1) (2) (3) (4)
21 - 402 - 01
C. IDENTITAS PEMOTONG
1. NPWP : C.01 00.139.629.0 - 924 . 000 3. TANGGAL & TANDA TANGAN
2. NAMA : C.02 FRANSISKA S. BLAANG C.03 31 - 01 - 2022

[dd - mm - yyyy]
KODE OBJEK PAJAK PENGHASILAN PASAL 21 ( FINAL)
1. 21-401-01 Uang Pesangon yang Dibayarkan Sekaligus

2. 21-401-02 Uang Manfaat Pensiun, Tunjangan Hari Tua, atau Jaminan Hari Tua yang Dibayarkan Sekaligus
3. 21-402-01 Honor dan Imbalan Lain yang Dibebankan kepada APBN atau APBD yang Diterima oleh PNS, Anggota TNI/POLRI, Pejabat
Negara dan Pensiunannya
4. 21-499-99 Objek PPh Pasal 21 Final Lainnya
STAPLES HANYA PADA BAGIAN INI
1770 SS
KEMENTERIAN KEUANGAN RI TAHUN PAJAK
DIREKTORAT JENDERAL PAJAK H.03 2 0 1 8
PERHATIAN :
SPT TAHUNAN
PAJAK PENGHASILAN DIISI OLEH PETUGAS KPP
▪ SEBELUM MENGISI BACA DAHULU PETUNJUK PENGISIAN
WAJIB PAJAK ORANG PRIBADI BARCODE DITEMPEL DISINI
▪ ISI DENGAN HURUF CETAK/DIKETIK DENGAN TINTA HITAM
▪ BERI TANDA 'X' PADA (KOTAK PILIHAN) YANG SESUAI H.01 SPT PEMBETULAN KE H.02 - ….
WAJIB PAJAK
IDENTITAS
NPWP I.01 : #N/A - #N/A - #N/A
NAMA WAJIB PAJAK I.02 : -
Pengisian kolom-kolom yang berisi nilai rupiah harus tanpa nilai desimal
A. PAJAK PENGHASILAN
1 Penghasilan Bruto dalam Negeri Sehubungan dengan Pekerjaan dan Penghasilan Netto dalam Negeri Lainnya 1 A.01 #N/A
2 Pengurangan
(Diisi jumlah pengurangan dari Formulir 1721-A1 angka 13 atau 1721-A2 angka 13)
2 A.02 #N/A
TK/ K/ K/I/
3 Penghasilan Tidak Kena Pajak A.03
#N/A A.04
#N/A A.05
- 3 A.06 #N/A
(Diisi jumlah PTKP dari Formulir 1721-A1 angka 17 atau 1721-A2 angka 16)
4 Penghasilan Kena Pajak ( 1 - 2 - 3 ) 4 A.07 #N/A
5 Pajak Penghasilan Terutang 5 A.08 #N/A
6 Pajak Penghasilan yang telah Dipotong oleh Pihak Lain 6 A.09 #N/A
7 a. A.10 X Pajak Penghasilan yang harus Dibayar Sendiri *

(5-6) 7 A.12 #N/A
b. A.11 Pajak Penghasilan yang Lebih Dipotong
B PENGHASILAN YANG DIKENAKAN PPh FINAL DAN YANG DIKECUALIKAN DARI OBJEK PAJAK
8 Dasar Pengenaan Pajak/Penghasilan Bruto Pajak Penghasilan Final 8 B.01
9 Pajak Penghasilan Final Terutang 9 B.02
10 Penghasilan yang Dikecualikan dari Objek Pajak 10 B.03
C DAFTAR HARTA DAN KEWAJIBAN
11 Jumlah Keseluruhan Harta yang Dimiliki pada Akhir Tahun Pajak 11 C.01
12 Jumlah Keseluruhan Kewajiban/Utang pada Akhir Tahun Pajak 12 C.02
PERNYATAAN
Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan peraturan perundang-undangan yang berlaku
Saya menyatakan bahwa apa yang telah saya beritahukan di atas adalah benar, lengkap, jelas.
P.01 20 - 01 - 2024
dd mm yyyy
TANDA TANGAN
* Apabila terdapat Pajak Penghasilan yang harus dibayar sendiri, Wajib Pajak harus melampirkan asli SSP lembar ke-3
2 0 1 8
SPT TAHUNAN
1770 S
TAHUN PAJAK
FORMULIR
PAJAK PENGHASILAN WAJIB PAJAK ORANG PRIBADI
BAGI WAJIB PAJAK YANG MEMPUNYAI PENGHASILAN :
KEMENTERIAN KEUANGAN RI • DARI SATU ATAU LEBIH PEMBERI KERJA; SPT PEMBETULAN KE - …
DIREKTORAT JENDERAL PAJAK • DALAM NEGERI LAINNYA; DAN/ATAU
• YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL.
PERHATIAN • SEBELUM MENGISI BACA DAHULU PETUNJUK PENGISIAN • ISI DENGAN HURUF CETAK /DIKETIK DENGAN TINTA HITAM • BERI TANDA "X" PADA (KOTAK PILIHAN) YANG SESUAI
NPWP : ###### ######### ######### ### ######### #########
NAMA WAJIB PAJAK : ########################################################################
PEKERJAAN : A S N KLU :
IDENTITAS
NO. TELEPON : - NO. FAKS : -
STATUS KEWAJIBAN : KK HB PH MT
PERPAJAKAN SUAMI-ISTERI
NPWP ISTERI / SUAMI :
Permohonan perubahan data disampaikan terpisah dari pelaporan SPT Tahunan PPh Orang Pribadi ini, dengan menggunakan Formulir
Perubahan Data Wajib Pajak dan dilengkapi dokumen yang disyaratkan.
*) Pengisian kolom-kolom yang berisi nilai rupiah harus tanpa nilai desimal (contoh penulisan lihat petunjuk pengisian halaman 3) RUPIAH *)
1 PENGHASILAN NETO DALAM NEGERI SEHUBUNGAN DENGAN PEKERJAAN …….………………………………………1 #N/A
[Diisi akumulasi jumlah penghasilan neto pada setiap Formulir 1721-A1 dan/atau 1721-A2 angka 14 yang dilampirkan atau Bukti Potong Lain]
2 PENGHASILAN NETO DALAM NEGERI LAINNYA …………………………………………………………………………………2 0

A. PENGHASILAN NETO
[Diisi sesuai dengan Formulir 1770 S-I Jumlah Bagian A ]
3 PENGHASILAN NETO LUAR NEGERI …………………………………………………………………………………………………3

[Apabila memiliki penghasilan dari luar negeri agar diisi dari Lampiran Tersendiri, lihat petunjuk pengisian]
4 JUMLAH PENGHASILAN NETO (1+2+3) ……………………………………………………………………………………… 4 #N/A
5 ZAKAT/SUMBANGAN KEAGAMAAN YANG SIFATNYA WAJIB ……………………………………………………………… 5
6 JUMLAH PENGHASILAN NETO SETELAH PENGURANGAN ZAKAT /SUMBANGAN KEAGAMAAN …………………… 6 #N/A
YANG SIFATNYA WAJIB (4-5)
B.PENGHASILAN
KENA PAJAK
7 PENGHASILAN TIDAK KENA PAJAK TK / ### K / ### K/I/ - 7 #N/A
8 PENGHASILAN KENA PAJAK (6-7) ……………………………………………………………………………………………. 8

#N/A
9 PPh TERUTANG (TARIF PASAL 17 UU PPh x ANGKA 8) ……………………………………………………………………

C. PPh TERUTANG
[Bagi Wajib Pajak dengan status PH atau MT diisi dari Lampiran Perhitungan PPh Terutang sebagaimana dimaksud dalam bagian G: 9 #N/A
Lampiran huruf d]
10 PENGEMBALIAN / PENGURANGAN PPh PASAL 24 YANG TELAH DIKREDITKAN …………………………………… 10
11 JUMLAH PPh TERUTANG (9+10) …………………………………………………………………………………………… 11 #N/A
12 PPh YANG DIPOTONG/DIPUNGUT PIHAK LAIN/DITANGGUNG PEMERINTAH DAN/ATAU KREDIT PAJAK LUAR 12 #N/A
NEGERI DAN/ATAU TERUTANG DI LUAR NEGERI [Diisi dari Formulir 1770 S-I Jumlah Bagian C Kolom (7)]
13 a. PPh YANG HARUS DIBAYAR SENDIRI …………………………………………………….. 13

D. KREDIT PAJAK
(11-12) #N/A
b. PPh YANG LEBIH DIPOTONG/DIPUNGUT
14 PPh YANG DIBAYAR SENDIRI a. PPh PASAL 25 …………………………………………………………………………14a
b. STP PPh Pasal 25 (Hanya Pokok Pajak) …………………………………………14b
15 JUMLAH KREDIT PAJAK (14a + 14b) …………………………………………………………………………………………

15 -
TGL LUNAS
E. PPh KURANG/LEBIH BAYAR
16 a. PPh YANG KURANG DIBAYAR (PPh PASAL 29)

(13-15) 16
b. PPh YANG LEBIH DIBAYAR (PPh PASAL 28 A) TGL BLN THN
#N/A
17 PERMOHONAN : PPh Lebih Bayar pada 16b mohon :

a. DIRESTITUSIKAN c. DIKEMBALIKAN DENGAN SKPPKP PASAL 17C (WP dengan Kriteria Tertentu)
b. DIPERHITUNGKAN DENGAN d. DIKEMBALIKAN DENGAN SKKPP PASAL 17D (WP yang Memenuhi Persyaratan Tertentu)
UTANG PAJAK
PAJAK BERIKUTNYA
F. ANGSURAN PPh
PASAL 25 TAHUN
18 ANGSURAN PPh PASAL 25 TAHUN PAJAK BERIKUTNYA 18

……………………………………………………………………………………………………………………..
SEBESAR
DIHITUNG BERDASARKAN :
a. 1/12 x JUMLAH PADA ANGKA 13
b. PENGHITUNGAN DALAM LAMPIRAN TERSENDIRI
Fotokopi Formulir 1721-A1 atau 1721-A2 atau Bukti Potong PPh Pasal 21 Perhitungan PPh Terutang bagi Wajib Pajak dengan status perpajakan PH atau MT
G. LAMPIRAN
a. X d.
b. Surat Setoran Pajak Lembar Ke-3 PPh Pasal 29 e. …………………………………………………………..
c. Surat Kuasa Khusus (Bila dikuasakan)
PERNYATAAN
Dengan menyadari sepenuhnya akan segala akibatnya termasuk sanksi-sanksi sesuai dengan ketentuan peraturan TANDA TANGAN
perundang-undangan yang berlaku, saya menyatakan bahwa yang telah beritahukan diatas beserta lampiran-lampirannya
adalah benar, lengkap dan jelas.
X WAJIB PAJAK KUASA TANGGAL 2 1 0 1 2 0 2 4

TGL BLN THN
NAMA LENGKAP : ### #########################################################
NPWP : ### ### ######### ######### ### ######### #########
F.1.1.32.18
LAMPIRAN - I
TAHUN PAJAK
FORMULIR
1770 S - I •
SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI
PENGHASILAN NETO DALAM NEGERI LAINNYA 2 0 1 8
KEMENTERIAN KEUANGAN RI
DIREKTORAT JENDERAL PAJAK
• PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK
• DAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN DAN PPh YANG DITANGGUNG
PEMERINTAH
NPWP : ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
NAMA WAJIB PAJAK : ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
BAGIAN A : PENGHASILAN NETO DALAM NEGERI LAINNYA

(TIDAK TERMASUK PENGHASILAN DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL)
JUMLAH PENGHASILAN
NO. JENIS PENGHASILAN
(Rupiah)
(1) (2) (3)
1. BUNGA
2. ROYALTI
3. SEWA
4. PENGHARGAAN DAN HADIAH
5. KEUNTUNGAN DARI PENJUALAN/PENGALIHAN HARTA
6. PENGHASILAN LAINNYA
JUMLAH BAGIAN A JBA 0

Pindahkan Jumlah Bagian A ke Formulir Induk 1770 S Bagian A
angka (2)
BAGIAN B : PENGHASILAN YANG TIDAK TERMASUK OBJEK PAJAK
JUMLAH PENGHASILAN
NO. JENIS PENGHASILAN
(Rupiah)
(1) (2) (3)
1. BANTUAN/SUMBANGAN/HIBAH
2. WARISAN
3. BAGIAN LABA ANGGOTA PERSEROAN KOMANDITER TIDAK ATAS SAHAM,

PERSEKUTUAN, PERKUMPULAN, FIRMA, KONGSI
4. KLAIM ASURANSI KESEHATAN, KECELAKAAN, JIWA, DWIGUNA, BEASISWA
5. BEASISWA
6. PENGHASILAN LAINNYA YANG TIDAK TERMASUK OBJEK PAJAK
JUMLAH BAGIAN B JBB 0
BAGIAN C : DAFTAR PEMOTONGAN/PEMUNGUTAN PPh OLEH PIHAK LAIN DAN PPh YANG DITANGGUNG PEMERINTAH
NAMA PEMOTONG/ NPWP PEMOTONG/ BUKTI PEMOTONGAN/ JENIS PAJAK : JUMLAH PPh YANG
NO PEMUNGUTAN PPh PASAL 21/
PEMUNGUT PAJAK PEMUNGUT PAJAK DIPOTONG / DIPUNGUT
NOMOR TANGGAL 22/23/24/26/DTP*
(1) (2) (3) (4) (5) (6) (7)
1.2-12.23-
BENDAHARA
1. DINAS KESEHATAN KABUPATEN MANGGARAI TIMUR
001396290924000 31/01/2022 PPh PASAL 21 #N/A
00000793
2.
3.
4.
5.
dst
JUMLAH BAGIAN C JBC #N/A
Pindahkan Jumlah Bagian C ke Formulir

Catatan : Induk 1770 S Bagian D angka 12
*) - DTP : Ditanggung Pemerintah
- Kolom (6) diisi dengan pilihan PPh Pasal 21/22/23/24/26/DTP (Contoh : ditulis 21, 22, 23, 24, 26, DTP)
- Jika terdapat kredit pajak PPh Pasal 24, maka jumlah yang diisi adalah maksimum yang dapat dikreditkan sesuai lampiran tersendiri
(lihat petunjuk pengisian tentang Lampiran I Bagian C dan Induk SPT angka 3)
JIKA FORMULIR INI TIDAK MENCUKUPI, DAPAT DIBUAT SENDIRI SESUAI DENGAN BENTUK INI Halaman ke- dari halaman Lampiran-I
Masa PajakTahun PajaPembetula Nomor Bukti PotongMasa PerolMasa PerolNPWP NIP
12 2023 0 1.2-12.16-0000001 01 12 41.953.869.9.924.0 #NAME?
12 2023 0 1.2-12.16-0000002 01 12 0 #NAME?
12 2023 0 #NAME? #NAME? #NAME? #NAME? #NAME?
12 2023 0 1.2-12.16-0000004 01 12 158389056924000 #NAME?
12 2023 0 1.2-12.16-0000005 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000006 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000007 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000008 01 12 16083224924000 #NAME?
12 2023 0 1.2-12.16-0000009 01 12 15.991,048..8924.0 #NAME?
12 2023 0 1.2-12.16-0000010 01 12 155687379924000 #NAME?
12 2023 0 1.2-12.16-0000017 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000018 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000019 01 12 15.667.147.1.924.0 #NAME?
12 2023 0 1.2-12.16-0000020 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000021 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000023 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000024 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000025 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000026 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000027 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000028 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000033 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000034 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000038 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000039 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000040 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000041 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000042 01 12 160429999924000 #NAME?
12 2023 0 1.2-12.16-0000043 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000044 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000045 01 12 160431151924000 #NAME?
12 2023 0 1.2-12.16-0000046 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000048 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000050 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000051 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000053 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000054 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000055 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000061 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000062 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000068 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000071 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000158 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000159 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000160 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000161 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000162 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000163 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000164 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000166 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000167 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000168 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000169 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000170 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000171 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000172 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000173 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000174 01 12 0 #NAME?
12 2023 0 1.2-12.16-0000175 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 160832184924000 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 161863626924000 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 160831293924000 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
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12 2023 0 #NAME? 01 12 0 #NAME?
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12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
12 2023 0 #NAME? 01 12 0 #NAME?
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Nama Pangkat Golongan Alamat Jenis Kela NIK Status PTKJumlah Ta Nama JabaKode Pajak
dr. SURIP PEMBINA U PEMBINA UBORONG F 196803191TK 1 KADIS 21-100-01
DR.HILDEGPEMBINA U PEMBINA UBORONG #N/A 1976120920 #N/A 2 DOKTER 21-100-01
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? 21-100-01
DR. MARI PEMBINA TK PEMBINA TK
BORONG F 19790805 2K 2 DOKTER 21-100-01
SUSANA PPEMBINA TK PEMBINA TK
BORONG #N/A 19850811 2 #N/A 2 STAF 21-100-01
PRUDENSIA PEMBINA TK
PEMBINA TK
BORONG #N/A 19791121 2 #N/A 0 STAF 21-100-01
HINDRAYAN PEMBINA TK
PEMBINA TK
BORONG #N/A 19840801 2 #N/A 0 STAF 21-100-01
SIPRIANUSPEMBINA /PEMBINA /BORONG M 19840922 2K 2 KEPALA P 21-100-01
PRANATA P KEMBINA /PEMBINA /BORONG F 198312242K 2 SEKRETAR21-100-01
TITUS DO PEMBINA /PEMBINA /BORONG M 197302061K 2 KABID 21-100-01
MARIA D. PENATA TK.IPENATA TK.I
BORONG #N/A 196908051 #N/A 0 KABID 21-100-01
BONEFASIPENATA TK.I PENATA TK.I
BORONG #N/A 197202071 #N/A 2 KABID 21-100-01
SILVIA AG PENATA TK.I
PENATA TK.I
BORONG F 19780822 2K 2 KASUBAG 21-100-01
DOMINIKUS PENATA TK.I
PENATA TK.I
BORONG #N/A 19771219 2 #N/A 2 KASUBAG 21-100-01
dr, SICILI PENATA TK.I
PENATA TK.I
BORONG #N/A 19780420 2 #N/A 1 DOKTER 21-100-01
dr, MARIA PENATA TK.I
PENATA TK.I
BORONG #N/A 19840814 2 #N/A 1 DOKTER 21-100-01
dr. MARIA PENATA TK.I
PENATA TK.I
BORONG #N/A 198805122 #N/A 2 DOKTER 21-100-01
SAVERIUSPENATA TK.I PENATA TK.I
BORONG #N/A 19840902 2 #N/A 2 KEPALA P 21-100-01
MARIA E. PENATA TK.IPENATA TK.I
BORONG #N/A 19820920 2 #N/A 2 STAF 21-100-01
HELENA YU PENATA TK.I
PENATA TK.I
BORONG #N/A 19840819 2 #N/A 0 STAF 21-100-01
KAROLINAPENATA TK.I PENATA TK.I
BORONG #N/A 19851128 2 #N/A 0 STAF 21-100-01
FABIANUSPENATA TK.I PENATA TK.I
BORONG #N/A 19820102 2 #N/A 2 STAF 21-100-01
FEMIDIANAPENATA TK.IPENATA TK.I
BORONG #N/A 19820828 2 #N/A 2 STAF 21-100-01
YASINTA KPENATA TK.IPENATA TK.I
BORONG #N/A 198208222 #N/A 0 STAF 21-100-01
YULIANA NPENATA TK.IPENATA TK.I
BORONG #N/A 19870726 2 #N/A 1 STAF 21-100-01
ANGELA MPENATA TK.I PENATA TK.I
BORONG #N/A 19880417 2 #N/A 0 STAF 21-100-01
KRISTINA PENATA TK.IPENATA TK.I
BORONG #N/A 197405251 #N/A 0 KASIE 21-100-01
KORNELISPENATA TK.I PENATA TK.I
RENSIWATI PENATA TK.I
PENATA TK.I
IRENIUS TPENATA TK.IPENATA TK.I
BORONG M 19840628 2K 2 KASIE 21-100-01
LIDIA SAN PENATA TK.I
PENATA TK.I
ESTAVIANU PENATA TK.I
PENATA TK.I
BORONG #N/A 198509202 #N/A 0 KASUABAG 21-100-01
JANUARIUS PENATA TK.I
PENATA TK.I
BORONG M 198709192K 2 KASIE 21-100-01
YUSTINCEPENATA TK.I PENATA TK.I
BORONG #N/A 19651215 1 #N/A 0 STAF 21-100-01
MARIA FATPENATA TK.I
PENATA TK.I
BORONG #N/A 19670401 1 #N/A 2 STAF 21-100-01
MARIA DOPENATA TK.I
PENATA TK.I
BORONG #N/A 19690929 1 #N/A 2 STAF 21-100-01
SITTI MARPENATA TK.I
PENATA TK.I
BORONG #N/A 19680810 1 #N/A 1 STAF 21-100-01
SISILIA S PENATA TK.I
PENATA TK.I
BORONG #N/A 19671128 1 #N/A 0 STAF 21-100-01
MARIA IVOPENATA TK.I
PENATA TK.I
BORONG #N/A 19710717 1 #N/A 2 STAF 21-100-01
AGUSTINUPENATA TK.I
PENATA TK.I
BORONG #N/A 19680414 1 #N/A 2 STAF 21-100-01
AMIR SARIPENATA TK.I
PENATA TK.I
BORONG #N/A 19690612 #N/A 2 STAF 21-100-01
YULIANA MPENATA TK.I
PENATA TK.I
BORONG #N/A 19651231 1 #N/A 2 STAF 21-100-01
SOFIA SETPENATA TK.I
PENATA TK.I
BORONG #N/A 19730513 2 #N/A 2 STAF 21-100-01
XAVERIUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19730120 1 #N/A 1 STAF 21-100-01
ERMELINDPENATA TK.I
PENATA TK.I
BORONG #N/A 19731129 2 #N/A 0 STAF 21-100-01
SOFIA ERSPENATA TK.I
PENATA TK.I
BORONG #N/A 19710312 2 #N/A 2 STAF 21-100-01
YOHANA LPENATA TK.I
PENATA TK.I
BORONG #N/A 19750309 2 #N/A 0 STAF 21-100-01
GRASIANAPENATA TK.I
PENATA TK.I
BORONG #N/A 19690508 1 #N/A 2 STAF 21-100-01
CAROLINAPENATA TK.I
PENATA TK.I
BORONG #N/A 1987012520 #N/A 2 STAF 21-100-01
VINCENTI PENATA TK.I
PENATA TK.I
BORONG #N/A 19770419 2 #N/A 0 STAF 21-100-01
MARIA RE PENATA TK.I
PENATA TK.I
BORONG #N/A 19740510 2 #N/A 0 STAF 21-100-01
SOFANYE PENATA TK.I
PENATA TK.I
BORONG #N/A 19770311 1 #N/A 2 STAF 21-100-01
PAULINA NPENATA TK.I
PENATA TK.I
BORONG #N/A 197211032 #N/A 0 STAF 21-100-01
SENIN BA PENATA TK.I
PENATA TK.I
BORONG #N/A 19730902 1 #N/A 2 STAF 21-100-01
MARIA LE PENATA TK.I
PENATA TK.I
BORONG #N/A 19730803 2 #N/A 2 STAF 21-100-01
THERESIAPENATA TK.I
PENATA TK.I
BORONG #N/A 19750627 1 #N/A 0 STAF 21-100-01
GENOVEVA PENATA TK.I
PENATA TK.I
BORONG #N/A 19730620 2 #N/A 2 STAF 21-100-01
MARIA SU PENATA TK.I
PENATA TK.I
BORONG #N/A 1978021320 #N/A 2 KEPALA P 21-100-01
MARIA JAYPENATA TK.I
PENATA TK.I
BORONG #N/A 19760519 2 #N/A 2 STAF 21-100-01
KAROLINAPENATA TK.I
PENATA TK.I
BORONG #N/A 19751104 2 #N/A 2 STAF 21-100-01
EDELBERTPENATA TK.I
PENATA TK.I
BORONG #N/A 19733005 2 #N/A 2 STAF 21-100-01
FRANSISKA PENATA TK.I
PENATA TK.I
BORONG #N/A 19730614 2 #N/A 2 STAF 21-100-01
EDIRENTIAPENATA TK.I
PENATA TK.I
BORONG #N/A 19730517 2 #N/A 2 STAF 21-100-01
ADELTRUDI PENATA TK.I
PENATA TK.I
BORONG #N/A 197404132 #N/A 0 STAF 21-100-01
DOROTEA PENATA TK.I
PENATA TK.I
BORONG #N/A 197601202 #N/A 0 STAF 21-100-01
KAMILUS PENATA TK.I
PENATA TK.I
BORONG #N/A 19771714 1 #N/A 2 STAF 21-100-01
RAFAEL MPENATA TK.I
PENATA TK.I
BORONG #N/A 196804262 #N/A 2 STAF 21-100-01
LUSIA E. PENATA TK.I
PENATA TK.I
BORONG #N/A 19750315 1 #N/A 0 STAF 21-100-01
MARIA TH PENATA TK.I
PENATA TK.I
BORONG #N/A 19780606 2 #N/A 0 STAF 21-100-01
PASKALIS PENATA TK.I
PENATA TK.I
FRANSISKPENATA TK.I
PENATA TK.I
BORONG #N/A 19790414 2 #N/A 2 STAF 21-100-01
LAMBERTIPENATA TK.I
PENATA TK.I
BORONG #N/A 19781128 2 #N/A 2 STAF 21-100-01
EVENSIA MPENATA TK.I
PENATA TK.I
BORONG #N/A 19710503 2 #N/A 0 STAF 21-100-01
OKTAVIANIPENATA TK.I
PENATA TK.I
BORONG #N/A 19781015 2 #N/A 2 STAF 21-100-01
SERGIUS PENATA TK.I
PENATA TK.I
VERONIKAPENATA TK.I
PENATA TK.I
BORONG #N/A 19820331 2 #N/A 0 STAF 21-100-01
FERDINANPENATA TK.I
PENATA TK.I
YULIANA PENATA TK.I
PENATA TK.I
YOSEFINAPENATA TK.I
PENATA TK.I
ADRIANUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19780419 2 #N/A 2 STAF 21-100-01
KRISPINUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19790205 2 #N/A 2 STAF 21-100-01
FRANSISKPENATA TK.I
PENATA TK.I
BORONG #N/A 19801028 2 #N/A 0 STAF 21-100-01
MARTA JUN PENATA TK.I
PENATA TK.I
BORONG #N/A 19801231 2 #N/A 2 STAF 21-100-01
VALENTINU PENATA TK.I
PENATA TK.I
BORONG #N/A 19810528 2 #N/A 2 STAF 21-100-01
HERMINA PENATA TK.I
PENATA TK.I
BORONG #N/A 19811120 2 #N/A 2 STAF 21-100-01
ADRIANA EPENATA TK.I
PENATA TK.I
BORONG #N/A 19820515 2 #N/A 2 STAF 21-100-01
ALEKSIUS PENATA TK.I
PENATA TK.I
BORONG #N/A 19820701 2 #N/A 2 STAF 21-100-01
THERESIAPENATA TK.I
PENATA TK.I
BORONG #N/A 19831003 2 #N/A 0 STAF 21-100-01
EUFRASIAPENATA TK.I
PENATA TK.I
BORONG #N/A 198202152 #N/A 0 STAF 21-100-01
ANGELA M.PENATA TK.I
PENATA TK.I
BORONG #N/A 198201252 #N/A 2 STAF 21-100-01
ELISABETH PENATA TK.I
PENATA TK.I
BORONG #N/A 19810609 2 #N/A 2 STAF 21-100-01
NOBERTUS PENATA TK.I
PENATA TK.I
STEFANUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19821014 2 #N/A 1 STAF 21-100-01
YASINTA FPENATA TK.I
PENATA TK.I
BORONG #N/A 19820430 2 #N/A 2 STAF 21-100-01
MARIA DALPENATA TK.I
PENATA TK.I
BORONG #N/A 19781123 2 #N/A 2 STAF 21-100-01
ALFRIDUS PENATA TK.I
PENATA TK.I
BORONG #N/A 198205252 #N/A 2 STAF 21-100-01
VINSENSI PENATA TK.I
PENATA TK.I
BORONG #N/A 19700204 2 #N/A 2 STAF 21-100-01
BERGITA PENATA TK.I
PENATA TK.I
BORONG #N/A 19800618 2 #N/A 0 STAF 21-100-01
MARGARET PENATA TK.I
PENATA TK.I
BORONG #N/A 19690603 2 #N/A 2 STAF 21-100-01
GABRIEL MPENATA TK.I
PENATA TK.I
BORONG #N/A 19751121 2 #N/A 2 STAF 21-100-01
FRIDUS S PENATA TK.I
PENATA TK.I
BORONG #N/A 19781020 2 #N/A 2 STAF 21-100-01
MARIA ALFPENATA TK.I
PENATA TK.I
BORONG #N/A 19850914 2 #N/A 0 STAF 21-100-01
MARIA G. PENATA TK.I
PENATA TK.I
HERIBERTPENATA TK.I
PENATA TK.I
ANASTASIA PENATA TK.I
PENATA TK.I
BORONG #N/A 19870427 2 #N/A 2 STAF 21-100-01
DOROTEUS PENATA TK.I
PENATA TK.I
BORONG #N/A 19760114 2 #N/A 2 STAF 21-100-01
PENATA TK.I
BORONG #N/A 19771123 2 #N/A 2 STAF 21-100-01
NURJALILAPENATA TK.I
PENATA TK.I
BORONG #N/A 19780511 2 #N/A 0 STAF 21-100-01
ANGELINAPENATA TK.I
PENATA TK.I
BORONG #N/A 19790420 2 #N/A 2 STAF 21-100-01
STEFANIA PENATA TK.I
PENATA TK.I
BORONG #N/A 19800126 2 #N/A 0 STAF 21-100-01
RITA, A.M PENATA TK.I
PENATA TK.I
BORONG #N/A 19800322 2 #N/A 2 STAF 21-100-01
DANIEL DOPENATA TK.I
PENATA TK.I
BORONG #N/A 198010122 #N/A 1 STAF 21-100-01
PETRUS NPENATA TK.I
PENATA TK.I
BORONG #N/A 19801226 2 #N/A 1 STAF 21-100-01
ANDREAS PENATA TK.I
PENATA TK.I
FLORA NDPENATA TK.I
PENATA TK.I
BORONG #N/A 19810803 2 #N/A 2 STAF 21-100-01
NUR SUWAI PENATA TK.I
PENATA TK.I
BORONG #N/A 19810809 #N/A 0 STAF 21-100-01
MARTINA PENATA TK.I
PENATA TK.I
BORONG #N/A 19820303 2 #N/A 0 STAF 21-100-01
IRENE IPAPENATA TK.I
PENATA TK.I
BORONG #N/A 198204032 #N/A 2 STAF 21-100-01
MATILDA PENATA TK.I
PENATA TK.I
BORONG #N/A 19820505 2 #N/A 0 STAF 21-100-01
MARIA EVO PENATA TK.I
PENATA TK.I
BORONG #N/A 19820529 2 #N/A 1 STAF 21-100-01
YUVENTUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19820627 2 #N/A 1 STAF 21-100-01
ANIK MASR PENATA TK.I
PENATA TK.I
BORONG #N/A 19820821 2 #N/A 0 STAF 21-100-01
HENDRIKAPENATA TK.I
PENATA TK.I
BORONG #N/A 198210062 #N/A 2 STAF 21-100-01
ELISABETH PENATA TK.I
PENATA TK.I
BORONG #N/A 19821022 2 #N/A 2 STAF 21-100-01
PENATA TK.I
BORONG #N/A 19821127 #N/A 0 STAF 21-100-01
VALERIA YPENATA TK.I
PENATA TK.I
BORONG #N/A 19821208 2 #N/A 2 STAF 21-100-01
GENOVEVA PENATA TK.I
PENATA TK.I
BORONG #N/A 19830103 2 #N/A 0 STAF 21-100-01
ALFERTIKAPENATA TK.I
PENATA TK.I
BORONG #N/A 19830107 2 #N/A 2 STAF 21-100-01
MARIA MOIPENATA TK.I
PENATA TK.I
BORONG #N/A 19830206 2 #N/A 2 STAF 21-100-01
FORTENSIU PENATA TK.I
PENATA TK.I
BORONG #N/A 19830222 2 #N/A 2 STAF 21-100-01
AMABILUSPENATA TK.I
PENATA TK.I
EDELTRUDI PENATA TK.I
PENATA TK.I
BORONG #N/A 19830623 2 #N/A 2 STAF 21-100-01
FLORENTIN PENATA TK.I
PENATA TK.I
BORONG #N/A 19830628 2 #N/A 2 STAF 21-100-01
MARIA NDO PENATA TK.I
PENATA TK.I
BORONG #N/A 19830711 2 #N/A 2 STAF 21-100-01
KUNIGUNDE PENATA TK.I
PENATA TK.I
BORONG #N/A 198307132 #N/A 0 STAF 21-100-01
AGUSTINUPENATA TK.I
PENATA TK.I
BORONG #N/A 19830508 2 #N/A 2 STAF 21-100-01
WAHYUNI P UENATA TK.I
PENATA TK.I
BORONG #N/A 19830906 2 #N/A 2 STAF 21-100-01
ERMELINDA PENATA TK.I
PENATA TK.I
BORONG #N/A 1983090920 #N/A 2 STAF 21-100-01
FATIMAH, PENATA TK.I
PENATA TK.I
BORONG #N/A 19831025 2 #N/A 0 STAF 21-100-01
AGUSTINUS PENATA TK.I
PENATA TK.I
BORONG #N/A 19831114 2 #N/A 1 STAF 21-100-01
AVENTINUPENATA TK.I
PENATA TK.I
BORONG #N/A 19831129 2 #N/A 2 STAF 21-100-01
MARIA F. PENATA TK.I
PENATA TK.I
BORONG #N/A 19831212 2 #N/A 2 STAF 21-100-01
ELSI NIRMPENATA TK.I
PENATA TK.I
BORONG #N/A 198312202 #N/A 2 STAF 21-100-01
DORFINA YPENATA TK.I
PENATA TK.I
BORONG #N/A 19840107 2 #N/A 0 STAF 21-100-01
MARIANA S PENATA TK.I
PENATA TK.I
BORONG #N/A 19840222 2 #N/A 1 STAF 21-100-01
ANTONIA HPENATA TK.I
PENATA TK.I
BORONG #N/A 19840509 2 #N/A 0 STAF 21-100-01
YOHANA E.PENATA TK.I
PENATA TK.I
BORONG #N/A 19840803 2 #N/A 0 STAF 21-100-01
AGUSTINAPENATA TK.I
PENATA TK.I
BORONG #N/A 19840808 2 #N/A 2 STAF 21-100-01
PONSIANUPENATA TK.I
PENATA TK.I
BORONG #N/A 198409012 #N/A 2 STAF 21-100-01
EMELINDAPENATA TK.I
PENATA TK.I
BORONG #N/A 198409022 #N/A 2 STAF 21-100-01
ELISABET PENATA TK.I
PENATA TK.I
BORONG #N/A 19840916 2 #N/A 0 STAF 21-100-01
EFRIANUSPENATA TK.I
PENATA TK.I
BORONG #N/A 19840916 2 #N/A 2 STAF 21-100-01
KORNELIAPENATA TK.I
PENATA TK.I
BORONG #N/A 19850220 2 #N/A 2 STAF 21-100-01
PENATA TK.I
BORONG #N/A 19850307 2 #N/A 2 STAF 21-100-01
CHRISTINAPENATA TK.I
PENATA TK.I
BORONG #N/A 19850313 2 #N/A 2 STAF 21-100-01
PAULINA YPENATA TK.I
PENATA TK.I
BORONG #N/A 19850331 2 #N/A 0 STAF 21-100-01
YOVINIANU PENATA TK.I
PENATA TK.I
BORONG #N/A 19850430 2 #N/A 2 STAF 21-100-01
AGNES IWA PENATA TK.I
PENATA TK.I
BORONG #N/A 19850430 2 #N/A 0 STAF 21-100-01
YUSTINA EPENATA TK.I
PENATA TK.I
BORONG #N/A 19850514 2 #N/A 0 STAF 21-100-01
WILIBRODPENATA TK.I
PENATA TK.I
BORONG #N/A 198505212 #N/A 2 STAF 21-100-01
BERGITA NPENATA TK.I
PENATA TK.I
BORONG #N/A 19850523 2 #N/A 2 STAF 21-100-01
YOHANA PPENATA TK.I
PENATA TK.I
BORONG #N/A 198505302 #N/A 2 STAF 21-100-01
EMILIA RIMPENATA TK.I
PENATA TK.I
BORONG #N/A 198506082 #N/A 1 STAF 21-100-01
MARIA GE PENATA TK.I
PENATA TK.I
BORONG #N/A 19850617 2 #N/A 0 STAF 21-100-01
PENATA TK.I
BORONG #N/A 19850621 2 #N/A 1 STAF 21-100-01
DOMINIKUS PENATA TK.I
PENATA TK.I
SABINUS DPENATA TK.I
PENATA TK.I
BORONG #N/A 19850731 2 #N/A 2 STAF 21-100-01
BENEDIKTPENATA TK.I
PENATA TK.I
BORONG #N/A 19850814 2 #N/A 1 STAF 21-100-01
VIKTORIA PENATA TK.I
PENATA TK.I
BORONG #N/A 19851102 2 #N/A 2 STAF 21-100-01
YASINTA SPENATA TK.I
PENATA TK.I
BORONG #N/A 198512162 #N/A 1 STAF 21-100-01
MARIA HER PENATA TK.I
PENATA TK.I
BORONG F 19851229 2K 1 STAF 21-100-01
BENEDIKTU PENATA TK.I
PENATA TK.I
BORONG #N/A 19860209 2 #N/A 1 STAF 21-100-01
MARIA G. PENATA TK.I
PENATA TK.I
BORONG #N/A 1986022020 #N/A 2 STAF 21-100-01
KILIAN JUFPENATA TK.I
PENATA TK.I
BORONG M 19860226 2K 2 STAF 21-100-01
MATILDA FPENATA TK.I
PENATA TK.I
BORONG #N/A 19860313 2 #N/A 2 STAF 21-100-01
EMILIA ERNPENATA TK.I
PENATA TK.I
BORONG F 19860414 2K 2 STAF 21-100-01
HILDA L. PENATA TK.I
PENATA TK.I
BORONG #N/A 19860428 2 #N/A 0 STAF 21-100-01
SERLIN N.PENATA TK.I
PENATA TK.I
BORONG #N/A 198605282 #N/A 2 STAF 21-100-01
YASINTA EPENATA TK.I
PENATA TK.I
BORONG #N/A 19860603 2 #N/A 2 STAF 21-100-01
TERESIA SPENATA TK.I
PENATA TK.I
BORONG #N/A 198606132 #N/A 2 STAF 21-100-01
PRISKA WIPENATA TK.I
PENATA TK.I
BORONG #N/A 19860723 2 #N/A 0 STAF 21-100-01
MARIA SUM PENATA TK.I
PENATA TK.I
BORONG #N/A 19860724 2 #N/A 2 STAF 21-100-01
ROSLINDAPENATA TK.IPENATA TK.I
BORONG #N/A 19860828 2 #N/A 2 STAF 21-100-01
KAROLINAPENATA TK.IPENATA TK.I
BORONG #N/A 19860923 2 #N/A 2 STAF 21-100-01
ROSALIA DPENATA TK.I
PENATA TK.I
BORONG #N/A 198610292 #N/A 0 STAF 21-100-01
APOLONIAPENATA TK.IPENATA TK.I
BORONG #N/A 19870102 2 #N/A 2 STAF 21-100-01
BENEDICTA PENATA TK.I
PENATA TK.I
BORONG #N/A 19870104 2 #N/A 2 STAF 21-100-01
ADRIANUSPENATA TK.IPENATA TK.I
BORONG #N/A 19870128 2 #N/A 1 STAF 21-100-01
BENEDIKTA PENATA TK.I
PENATA TK.I
BORONG #N/A 198702062 #N/A 2 STAF 21-100-01
MARIA E.JPENATA TK.I
PENATA TK.I
BORONG #N/A 19870208 2 #N/A 0 STAF 21-100-01
MARIA S. PENATA TK.I
PENATA TK.I
BORONG #N/A 19870210 2 #N/A 2 STAF 21-100-01
MARIA K.VPENATA TK.I
PENATA TK.I
BORONG #N/A 19870221 2 #N/A 2 STAF 21-100-01
TERESIA RPENATA TK.I
PENATA TK.I
BORONG #N/A 198706092 #N/A 1 STAF 21-100-01
MARIA CH.PENATA TK.I
PENATA TK.I
BORONG #N/A 19870723 2 #N/A 2 STAF 21-100-01
MARIANI PENATA TK.IPENATA TK.I
BORONG #N/A 198708052 #N/A 2 STAF 21-100-01
GUSTIANAPENATA TK.IPENATA TK.I
BORONG #N/A 19870807 2 #N/A 0 STAF 21-100-01
AGUSTINAPENATA TK.IPENATA TK.I
BORONG #N/A 19870813 2 #N/A 2 STAF 21-100-01
NOVAYANT PENATA TK.I
PENATA TK.I
BORONG #N/A 19871115 2 #N/A 0 STAF 21-100-01
AGNESTIAPENATA TK.IPENATA TK.I
BORONG #N/A 19871119 2 #N/A 2 STAF 21-100-01
MARIA GOR PENATA TK.I
PENATA TK.I
BORONG #N/A 19871202 2 #N/A 0 STAF 21-100-01
ERWINDA PENATA TK.IPENATA TK.I
BORONG #N/A 19880204 2 #N/A 2 STAF 21-100-01
MARIASNAPENATA TK.IPENATA TK.I
BORONG #N/A 19880604 2 #N/A 0 STAF 21-100-01
YOHANA E.PENATA TK.I
PENATA TK.I
BORONG #N/A 19880714 2 #N/A 0 STAF 21-100-01
ANASTASIA PENATA TK.I
PENATA TK.I
BORONG #N/A 1989032920 #N/A 2 STAF 21-100-01
MARIA KUR PENATA TK.I
PENATA TK.I
BORONG #N/A 19890409 2 #N/A 2 STAF 21-100-01
YOHANES PENATA
S TK.I
PENATA TK.I
MARTA ROS PENATA TK.I
PENATA TK.I
BORONG #N/A 19830729 2 #N/A 2 STAF 21-100-01
ELFIRA SEPENATA TK.I
PENATA TK.I
BORONG #N/A 19850719 2 #N/A 2 STAF 21-100-01
WILHELMIN PENATA TK.I
PENATA TK.I
BORONG #N/A 19860309 2 #N/A 2 STAF 21-100-01
FRANSISKPENATA TK.IPENATA TK.I
BORONG #N/A 198604032 #N/A 1 STAF 21-100-01
KAROLUS P L ENATA TK.I
PENATA TK.I
BORONG #N/A 1986060320 #N/A 0 STAF 21-100-01
ELVIRA SAPENATA TK.I
PENATA TK.I
BORONG #N/A 19860806 2 #N/A 0 STAF 21-100-01
NATANAELPENATA TK.IPENATA TK.I
BORONG #N/A 198609032 #N/A 1 KAPUS 21-100-01
EMILIANA PENATA TK.I
PENATA TK.I
BORONG #N/A 19870607 2 #N/A 0 STAF 21-100-01
BONEVANTU PENATA TK.I
PENATA TK.I
BORONG #N/A 1987071520 #N/A 1 STAF 21-100-01
YOSEFINAPENATA TK.IPENATA TK.I
BORONG F 19871127 2TK 0 STAF 21-100-01
SERLIYANT PENATA TK.I
PENATA TK.I
BORONG #N/A 1988061120 #N/A 2 STAF 21-100-01
FATIMA NUPENATA TK.I
PENATA TK.I
BORONG #N/A 19771216 #N/A 2 STAF 21-100-01
IRENE JENPENATA TK.I
PENATA TK.I
BORONG #N/A 19800225 2 #N/A 0 STAF 21-100-01
ANATALIA PENATA TK.I
PENATA TK.I
BORONG #N/A 19820709 2 #N/A 0 STAF 21-100-01
TIYANTI S PENATA TK.I
PENATA TK.I
BORONG #N/A 19811206 2 #N/A 2 STAF 21-100-01
EFLINA JEPENATA TK.IPENATA TK.I
BORONG #N/A 19830323 2 #N/A 0 STAF 21-100-01
YOHANES PENATA
J TK.I
PENATA TK.I
BORONG #N/A 19840626 2 #N/A 2 STAF 21-100-01
PENATA TK.I
BORONG #N/A 19860630 2 #N/A 0 STAF 21-100-01
PETRONELPENATA TK.I PENATA TK.I
BORONG #N/A 19860906 2 #N/A 0 STAF 21-100-01
GRADIANAPENATA TK.I PENATA TK.I
BORONG #N/A 19870120 2 #N/A 0 STAF 21-100-01
MARIANA M PENATA TK.I
PENATA TK.I
BORONG #N/A 19870510 2 #N/A 2 STAF 21-100-01
LAURENS PENATA TK.I PENATA TK.I
BORONG #N/A 19730128 2 #N/A 2 STAF 21-100-01
MARIA K. PENATA TK.IPENATA TK.I
BORONG #N/A 19840716 2 #N/A 2 STAF 21-100-01
ADOLFUS P WENATA TK.I
PENATA TK.I
MARIA DIAPENATA TK.IPENATA TK.I
BORONG #N/A 198212072 #N/A 0 STAF 21-100-01
WALDETRUD PENATA TK.I
PENATA TK.I
BORONG #N/A 198212202 #N/A 2 STAF 21-100-01
BURHANUS PENATA TK.I
PENATA TK.I
BORONG #N/A 198307032 #N/A 2 STAF 21-100-01
TERESIA BPENATA TK.IPENATA TK.I
BORONG #N/A 19840328 2 #N/A 0 STAF 21-100-01
YUSTINUSPENATA TK.I PENATA TK.I
BORONG #N/A 19840524 2 #N/A 2 STAF 21-100-01
AFRADIANA PENATA TK.I
PENATA TK.I
BORONG #N/A 19851204 2 #N/A 2 STAF 21-100-01
NATALIA PPENATA TK.IPENATA TK.I
BORONG #N/A 19871225 2 #N/A 0 STAF 21-100-01
RIKARDUSPENATA TK.I PENATA TK.I
BORONG M 198904092K 2 STAF 21-100-01
YENI JULAPENATA / IPENATA / IBORONG #N/A 19831106 2 #N/A 2 STAF 21-100-01
YULIANA PENATA / IPENATA / IBORONG #N/A 19860601 2 #N/A 2 STAF 21-100-01
MARIANUSPENATA / IPENATA / IBORONG M 198502112K 2 KASIE 21-100-01
IRENE ROS PENATA / IPENATA / IBORONG F 198504032K 1 KASIE 21-100-01
MELKI PARPENATA / IPENATA / IBORONG #N/A 198705162 #N/A 0 KASIE 21-100-01
ELBERTUSPENATA / IPENATA / IBORONG #N/A 19720225 1 #N/A 2 STAF 21-100-01
MARIA ER PENATA / IPENATA / IBORONG #N/A 19750821 2 #N/A 0 STAF 21-100-01
KRISTINA PENATA / IPENATA / IBORONG #N/A 19660618 2 #N/A 0 STAF 21-100-01
ERMELINDPENATA / IPENATA / IBORONG #N/A 19780425 2 #N/A 2 STAF 21-100-01
SISILIA M PENATA / IPENATA / IBORONG #N/A 19780214 2 #N/A 2 STAF 21-100-01
DIANA NIRPENATA / IPENATA / IBORONG #N/A 19730806 2 #N/A 0 STAF 21-100-01
VERIDIANAPENATA / IPENATA / IBORONG #N/A 19770922 2 #N/A 2 STAF 21-100-01
ROSALIA PENATA / IPENATA / IBORONG #N/A 19720903 2 #N/A 2 STAF 21-100-01
ANJELINA PENATA / IPENATA / IBORONG #N/A 197602292 #N/A 2 STAF 21-100-01
MELKIA ASPENATA / IPENATA / IBORONG #N/A 19741102 2 #N/A 0 STAF 21-100-01
AGUSTINUPENATA / IPENATA / IBORONG #N/A 196710261 #N/A 2 STAF 21-100-01
YOSEF BUPENATA TK.I PENATA TK.I
BORONG #N/A 19820801 2 #N/A 2 STAF 21-100-01
MERLIN E PENATA / IPENATA / IBORONG #N/A 19820519 2 #N/A 0 STAF 21-100-01
MARIANA N PENATA / IPENATA / IBORONG #N/A 19830630 2 #N/A 0 STAF 21-100-01
KASMIR N PENATA / IPENATA / IBORONG #N/A 19690404 2 #N/A 2 STAF 21-100-01
IRMINA JEPENATA / IPENATA / IBORONG #N/A 19830115 2 #N/A 2 STAF 21-100-01
MARIA EPIPENATA / IPENATA / IBORONG #N/A 19820117 2 #N/A 2 STAF 21-100-01
SISILIA MEPENATA / IPENATA / IBORONG #N/A 19811113 2 #N/A 0 STAF 21-100-01
MARSELUS PENATA / IPENATA / IBORONG #N/A 19750421 2 #N/A 2 STAF 21-100-01
AMBROSIAPENATA / IPENATA / IBORONG #N/A 19841207 2 #N/A 0 STAF 21-100-01
ANSELMUS PENATA / IPENATA / IBORONG #N/A 19670903 2 #N/A 2 STAF 21-100-01
BONEVANTU PENATA / IPENATA / IBORONG #N/A 19830715 2 #N/A 2 STAF 21-100-01
MARWIAH,PENATA / IPENATA / IBORONG #N/A 19831010 2 #N/A 2 STAF 21-100-01
PEREGRINA PENATA / IPENATA / IBORONG #N/A 19850516 2 #N/A 0 STAF 21-100-01
NURMAYA,PENATA / IPENATA / IBORONG #N/A 198511022 #N/A 1 STAF 21-100-01
GERADUS PENATA / IPENATA / IBORONG #N/A 19780628 2 #N/A 2 KEPALA P 21-100-01
LODOVIKUPENATA / IPENATA / IBORONG #N/A 19830503 2 #N/A 2 STAF 21-100-01
SISILIA YAPENATA / IPENATA / IBORONG #N/A 19830822 2 #N/A 2 STAF 21-100-01
MARTINA PENATA / IPENATA / IBORONG #N/A 19780416 2 #N/A 0 STAF 21-100-01
MARSELINPENATA / IPENATA / IBORONG F 19801117 2K 2 STAF 21-100-01
WILHELMIN PENATA / IPENATA / IBORONG #N/A 19821003 2 #N/A 2 STAF 21-100-01
EFRAMUS PENATA
R / IPENATA / IBORONG #N/A 19861010 2 #N/A 2 STAF 21-100-01
YOFITA SUPENATA / IPENATA / IBORONG #N/A 19870215 2 #N/A 0 STAF 21-100-01
ADRIANUSPENATA / IPENATA / IBORONG #N/A 19840313 2 #N/A 2 STAF 21-100-01
RAHMIYATIPENATA / IPENATA / IBORONG #N/A 19910222 2 #N/A 1 STAF 21-100-01
MARIA FATPENATA / IPENATA / IBORONG #N/A 1989082520 #N/A 0 STAF 21-100-01
REGINA MPENATA / IPENATA / IBORONG #N/A 19740128 2 #N/A 0 STAF 21-100-01
HERONIMAPENATA / IPENATA / IBORONG #N/A 19780218 2 #N/A 2 STAF 21-100-01
Jumlah 1 Jumlah 2 Jumlah 3 Jumlah 4 Jumlah 5 Jumlah 6 Jumlah 7
69291600 0 1,187,856 70479456 0 26325000 1738080
#N/A #N/A #N/A #N/A #N/A #N/A #N/A
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?
45864000 4586400 1,834,560 52284960 0 14400000 3476160
45864000 4586400 1,834,560 52284960 0 11050000 3476160
44002800 4400280 1,760,112 50163192 0 16380000 3476160
53000400 5300040 2,120,016 60420456 0 12740000 3476160
44917200 4491720 1,796,688 51205608 0 7020000 3476160
42217200 4221720 1,688,688 48127608 0 7020000 3476160
42217200 4221720 1,688,688 48127608 0 7020000 3476160
40927200 4092720 818,544 45838464 0 6500000 2607120
40927200 4092720 1,637,088 46657008 0 6500000 3476160
40927200 4092720 1,637,088 46657008 0 6500000 3476160
39678000 0 0 39678000 0 6500000 869040
42217200 4221720 1,688,688 48127608 0 2405000 3476160
39266400 3926640 1,570,656 44763696 0 7020000 3476160
39266400 3926640 785,328 43978368 0 7020000 2607120
39266400 3926640 1,570,656 44763696 0 6500000 3476160
Jumlah 8 Jumlah 9 Jumlah 10 Jumlah 11 Jumlah 12 Jumlah 13 Jumlah 14 Jumlah 15 Jumlah 16
0 88 0 98542624 4927131.2 3347774 8274905.2 90267718.8 0
#N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A #N/A
#NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME? #NAME?
0 80 0 70161200 3508060 2483536 5991596 64169604 0
0 80 0 66811200 3340560 2483536 5824096 60987104 0
0 616 0 70019968 3500998.4 2382752 5883750.4 64136217.6 0
0 88 0 76636704 3831835.2 2869972 6701807.2 69934896.8 0
0 784 0 61702552 3085127.6 2432266 5517393.6 56185158.4 0
0 784 0 58624552 2931227.6 2286061 5217288.6 53407263.4 0
0 784 0 58624552 2931227.6 2286061 5217288.6 53407263.4 0
0 72 0 54945656 2747282.8 2177327 4924609.8 50021046.2 0
0 984 0 56634152 2831707.6 2216208 5047915.6 51586236.4 0
0 984 0 56634152 2831707.6 2216208 5047915.6 51586236.4 0
0 0 0 47047040 2352352 1884705 4237057 42809983 0
0 784 0 54009552 2700477.6 2286061 4986538.6 49023013.4 0
0 608 0 55260464 2763023.2 2126276 4889299.2 50371164.8 0
0 264 0 53605752 2680287.6 2088972 4769259.6 48836492.4 0
0 608 0 54740464 2737023.2 2126276 4863299.2 49877164.8 0
Jumlah 17 Jumlah 18 Jumlah 19 Jumlah 20 Jumlah 21 Jumlah 22 Jumlah 23 Jumlah 23aJumlah 23b
90267718.8 54000000 36267718.8 1813350 0 1813350 0 1813350 0
64169604 54000000 10169604 508450 0 508450 0 508450 0
60987104 67500000 0 0 0 0 0 0 0
64136217.6 54000000 10136217.6 506800 0 506800 0 506800 0
69934896.8 67500000 2434896.8 121700 0 121700 0 121700 0
56185158.4 54000000 2185158.4 109250 0 109250 0 109250 0
53407263.4 67500000 0 0 0 0 0 0 0
53407263.4 67500000 0 0 0 0 0 0 0
50021046.2 54000000 0 0 0 0 0 0 0
51586236.4 67500000 0 0 0 0 0 0 0
51586236.4 54000000 0 0 0 0 0 0 0
42809983 54000000 0 0 0 0 0 0 0
49023013.4 67500000 0 0 0 0 0 0 0
50371164.8 67500000 0 0 0 0 0 0 0
48836492.4 54000000 0 0 0 0 0 0 0
49877164.8 54000000 0 0 0 0 0 0 0
Status Pin NPWP PemNama PemoTanggal BuktiInstansi P NIP Pemotong
001396290FRANSISKA
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LAMPIRAN - II
TAHUN PAJAK
1770 S - II 1 8
FORMULIR
SPT TAHUNAN PPh WAJIB PAJAK ORANG PRIBADI
2 0
• PENGHASILAN YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL
KEMENTERIAN KEUANGAN RI • HARTA PADA AKHIR TAHUN
DIREKTORAT JENDERAL PAJAK • KEWAJIBAN/UTANG PADA AKHIR TAHUN
• DAFTAR SUSUNAN ANGGOTA KELUARGA
NPWP : ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
NAMA WAJIB PAJAK : ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ### ###
BAGIAN A : PENGHASILAN YANG DIKENAKAN PPh FINAL DAN/ATAU BERSIFAT FINAL

DASAR PENGENAAN PAJAK/
NO. SUMBER/JENIS PENGHASILAN PPh TERUTANG
PENGHASILAN BRUTO
(Rupiah) (Rupiah)
(1) (2) (3) (4)
BUNGA DEPOSITO, TABUNGAN, DISKONTO SBI, SURAT
1.
BERHARGA NEGARA
2. BUNGA/DISKONTO OBLIGASI
3. PENJUALAN SAHAM DI BURSA EFEK
4. HADIAH UNDIAN
PESANGON, TUNJANGAN HARI TUA DAN TEBUSAN PENSIUN

5.
YANG DIBAYARKAN SEKALIGUS
6. HONORARIUM ATAS BEBAN APBN/APBD
7. PENGALIHAN HAK ATAS TANAH DAN/ATAU BANGUNAN
8. SEWA ATAS TANAH DAN/ATAU BANGGUNAN
BANGUNAN YANG DITERIMA DALAM RANGKA BANGUN GUNA

9.
SERAH
BUNGA SIMPANAN YANG DIBAYARKAN OLEH KOPERASI
10.
KEPADA ANGGOTA KOPERASI
11. PENGHASILAN DARI TRANSAKSI DERIVATIF
12. DIVIDEN
13. PENGHASILAN ISTERI DARI SATU PEMBERI KERJA
PENGHASILAN LAIN YANG DIKENAKAN PAJAK FINAL

14.
DAN/ATAU BERSIFAT FINAL
JUMLAH BAGIAN A JBA 0
BAGIAN B : HARTA PADA AKHIR TAHUN

KODE TAHUN
NO. NAMA HARTA HARGA PEROLEHAN KETERANGAN
HARTA PEROLEHAN (Rupiah)
(1) (2) (3) (4) (5) (6)
1. 014 DEPOSITO
2. 022 PIUTANG AFILIASI
3. 011 UANG TUNAI
4. 043 MOBIL
5.
032 SAHAM
dst
JUMLAH BAGIAN B JBB 0
BAGIAN C : KEWAJIBAN/UTANG PADA AKHIR TAHUN

KODE ALAMAT TAHUN
NO. NAMA PEMBERI PINJAMAN JUMLAH
UTANG PEMBERI PINJAMAN PEMINJAMAN
(1) (2) (3) (4) (5) (6)
1 101 HUTANG BANK/LEMBAGA KEUANGAN BUKAN BANK (KPR,
LEASING KENDARAAN BERMOTOR, DAN SEJENISNYA)
2 - KARTU KREDIT
3 - UTANG LAINNYA
4 - HUTANG BANK/LEMBAGA KEUANGAN BUKAN BANK (KPR,

LEASING KENDARAAN BERMOTOR, DAN SEJENISNYA)
5
dst -
JUMLAH BAGIAN C JBC 0
BAGIAN D : DAFTAR SUSUNAN ANGGOTA KELUARGA
NO. NAMA NIK HUBUNGAN KELUARGA PEKERJAAN
(1) (2) (3) (4) (5)

1
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Aplikasi 1721-A2 Dan SPT 1770 S 1770 Ss - Final

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Aplikasi 1721-A2 Dan SPT 1770 S 1770 Ss - Final

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APLIKASI PEMBUATAN

A2, 1770SS DAN 1770S-1721

IDENTITAS BUAT BUKTI POTONG

APLIKASI BUKTI POTONG A2 1770SS 1770S

TAHUN PAJAK 2021 INPUT DATA

NAMA KPP KPP Pratama Ruteng FORM 1721-A2 SPT 1770 S

TAHUN PAJAK 2023

NAMA INSTANSI / BADAN LAIN DINAS KESEHATAN KABUPATEN MANGGARAI

BENDAHARA DINAS KESEHATAN KABUPATEN

NPWP INSTANSI / BADAN 001396290924000

ALAMAT INSTANSI / BADAN LEHONG

NAMA PIMPINAN / PEMOTONG PAJAK FRANSISKA S. BLAANG

NIP PIMPINAN / PEMOTONG PAJAK 19860308 200804 2 002

TANGGAL PEMBUATAN SPT 31012022

PEKERJAAN PEGAWAI NEGERI SIPIL

002 19761209200501 2 013

003 19830225 200804 2 001

004 19790805 201001 2 025

005 19850811 201001 2 032

006 19791121 200501 2 016

007 19840801 200901 2 001

021 19780420 201408 2 001

022 1985031120 1 5032005

023 19840814 201403 2 001

026 19820920 200903 2 010

028 19851128 201101 2 017

030 19830203 200903 2 014

031 19850119 201101 2 029

032 19870521 201101 1 008

034 19820828 201101 2 014

035 19870726 201212 2 002

036 19880417 201212 2 002

046 19651215 198703 2 014

047 19680810 198903 2 011

048 19670401 198903 2 018

049 19671128 199001 2 001

050 19690929 199103 2 015

052 19730513 200212 2 004

054 19690612 1993031018

055 19730120 199312 1 002

056 19651231 199603 2 021

057 19710312 200112 2 002

059 19770419 200312 2 006

061 19731129 200012 2 003

063 19730620 200112 2 003

065 197802132004 06 2019

068 19750309 200604 2 018

069 19733005 200604 2 017

071 19690508 199703 2 005

072 19770311 199703 1 009

075 19730902 199703 1 007

076 19730803 200012 2 005

077 19750315 199803 2 005

078 19750627 199703 2 004

080 19760519 200604 2 017

082 19730517 200604 2 029

083 19710503 200903 2 001

084 19781015 200604 2 024

087 19780606 200604 2 045

088 19790412 199903 1 003

089 19790414 200501 2 027

092 19820331 200012 2 001

093 19740318 200604 1 011