Surat Keterangan Kkn

Post on 13-Jan-2016

9 views 0 download

description

contoh file surat keterangan kuliah kerja Nyata UNS di wonogiri

Transcript of Surat Keterangan Kkn

PEMERINTAH KABUPATEN WONOGIRIKECAMATAN NGUNTORONADIKEPALA DESA WONOHARJOJl. Raya Wonogiri Pacitan KM 25 57671

SURAT KETERANGANNOMOR : ......................

Yang bertanda tangan di bawah ini menerangkan bahwa :Nama: ...................................................................................................Tempat tanggal lahir: ...................................................................................................Alamat: ...................................................................................................Pekerjaan: ...................................................................................................Kewarganegaraan: ...................................................................................................Status Perkawinan: ...................................................................................................Agama: ...................................................................................................No KK: ...................................................................................................NIK : ...................................................................................................Keperluan: ................................................................................................... ...................................................................................................Berlaku mulai: ........................................................ s/d ....................................Keterangan lain: ................................................................................................... ....................................................................................................Demikianlah surat keterangan ini dibuat dan kepada instansi terkait untuk memberikan pelayanan seperlunyaNomor:.................................Tanggal: .................................

MengetahuiWonoharjo, .................Pemegang suratCamat NguntoronadiKepala Desa Wonoharjo

..........................................................................................................