ISIAN SURAT

PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa
b. Kecamatan

TARAWEANG
: LABAKKANG

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

JUMALIA

7310074502910002

SUNGGU

7310074304750002

ERNAWATI

7310075304950001

SANIASA D

7310074502610002

IWAN

7310073012830004

ADI
YANTI
ABDULLAH
SURIANI
DANIAL
UMAR
NURLINDA
MARWIAH
M. ARAFAH
NAAREATI
NURLINA ARAFAH
USMAN
MUH. YUSUF
NURSIA
NURHAEDA
BADA
SUADA
SUNARTI
MULIATI
MUSAKKIR
RAMLI
NURHAYATI
RAMLAH
RANO KARNO

7310071201900003
7310077112910008
7310073011700003
7310076006760002
7310070906940007
7310072302960001
7310076604980006
7310074306550001
7310070202590001
7310074710680001
7310075502840003
7310071705950002
7310073112750040
7310074051280003
7310074104970005
7310074304700001
7310077112590002
7310075009800001
7310074103880001
7310070702870004
7310072601580001
7310074507670002
7310074407880001
7310071904990001

L
P
L
P
L
L
P
P
L
P
P
L
L
P
P
P
P
P
P
L
L
P
P
L

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74

ILHAM
AMIR KAN
KASMAWATI
HASNIA
SAMAILA
MUHAMMAD
HASNA M
SALAMA
UMAR
ABD. RAHMAN J
ABDULLAH
NURSIAH
MASATI
WAHYUNI
HAMSIA
SALWIAH
CANDANG LOCONG
ERNI
SUKMAWATI
KARTIA
HALIMA
RAHMAN
MULIATI
RISNAWATI
LISMA AULIA
NURHIKMA
KASMAWATI
SAMSIA
NURWAHIDAH
ASNI SUGIANA
HASRA
NURJANNAH
SYAMSUDDIN
NURTANG
MEGAWATI
HASNI
PARLIADI
SUADA
SUKRIADI
ST RAHMA
ABD. RAHMAN
HABIBA
MARWAH
RUMBUNG
SIA

7310070303970001
7310070107830439
7310074202740005
7310076007050004
7310072104520002
7310070711510001
7310074112700002
7310071908780001
7310071103830001
7310070404840006
7310073012650007
7310075808710003
7310075511700004
7310071508850002
7310075406670001
7310074309860002
7310076012680002
7310074407850001
7310076305910002
7310074407760002
7310075702770002
7310070710910002
7310074804780001
7310077012930001
7310075708950003
7310075008930002
7310075011760001
7310075007880006
7310075012770001
7310075608690001
7310075910750003
7310074408780001
7310071507660001
7310076103850003
7310077005950001
7310074707700002
7310072008760001
7310074107770053
7100771104880001
7310074406700001
7310070808840001
2102094307670001
7310074505780015
7310070504430002
7310076311500001

L
L
P
P
L
L
P
P
L
L
L
P
P
P
P
P
P
P
P
P
P
L
P
P
P
P
P
P
P
P
P
P
L
P
P
P
L
P
L
P
L
P
P
L
P

75
76
77
78
79
80
81
82
83
84
85
86

SULAEMAN
MARNIATI
NABA
KASMA
SULAEMAN
MUH SAID
MIRANA
BAHRA
MULIANA
PUJIANA
MIRDA

7310072009660001
7310076805900001
7310070207720005
7310074607760007
7310076069700003
7310070112510001
7310074512600001
7310076109810004
7310075210850003
7310076004940001
7310076806980001

L
P
L
P
L
L
P
P
P
P
P

PENDAFTARAN

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

KAMPUNG TEPPOE

002/006

TARAWEANG

KP MATTOANNGING

002/005

TARAWEANG

KP MATTOANNGING

002/005

TARAWEANG

KP BATU BATU

002/003

TARAWEANG

KP BATU BATU

002/003

TARAWEANG

KP BATU BATU
KP BATU BATU
GATTA GATTARENG
GATTA GATTARENG
GATTA GATTARENG
GATTA GATTARENG
GATTA GATTARENG
GATTA GATTARENG
KP TEPPOE
KP TEPPOE
KP TEPPOE
KP TEPPOE
KP BARU
KP BARU
KP BARU
KP TEPPOE
KP TABORA
KP TABORA
KP TABORA
KP TABORA
KP MASIGI
KP MASIGI
KP MASIGI
KP MASIGI

002/003
002/003
001/004
001/004
001/004
001/004
001/004
001/004
002/006
002/006
002/006
002/006
002/006
002/006
002/006
001/006
003/005
003/005
003/005
003/005
002/002
002/002
002/002
002/002

TARAWEANG
TARAWEANG
LEMBANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
LEMBANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG

KP MASIGI
BALLA SIBATUA
BALLA SIBATUA
BALLA SIBATUA
BALLA SIBATUA
KP MASIGI
KP MASIGI
KP MASIGI
KP MASIGI
BEROANGIN
KP PALU
KP BATU BATU
KP TEPPOE
KP TEPPOE
KP TEPPOE
KP TEPPOE
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP TEPPOE
KP BATU BATU
KP BATU BATU
KP TEPPOE
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP BATU BATU
GATTA GATTARENG
KP TEPPOE
KP MATTOANNGING
KP BARU
KP TARAWEANG
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP BATU BATU
KP TEPPOE
KP BATU BATU
KP BARU
KP BARU
KP BATU BATU
KP TARAWEANG
KP TARAWEANG

002/002
002/004
002/004
002/004
002/004
002/002
002/002
002/002
002/002
001/006
004/002
001/003
002/006
002/006
002/006
002/006
001/006
002/003
001/003
002/006
001/003
001/003
002/006
001/003
001/003
001/003
001/003
001/005
001/003
001/004
002/006
002/006
002/006
001/001
001/003
001/003
001/003
001/003
002/006
001/003
002/006
002/006
002/003
001/001
001/001

TARAWEANG
MAROS
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
BEROANGIN
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
ATTANG SALO
TARAWEANG
TARAWEANG
TARAWEANG
BANTIMURUNG
KP BARU
PASSIKKI
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
BULU SIPONG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
LABBAKKANG
BUNGORO
TARAWEANG
TARAWEANG
SIPANGAH
TARAWEANG
TARAWEANG
TARAWEANG
LABBAKKANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG

KP
KP
KP
KP
KP
KP
KP
KP
KP
KP
KP

TARAWEANG
TARAWEANG
MATTOANNGING
MATTOANNGING
MATTOANNGING
BARU
BARU
BARU
BARU
BARU
BARU

001/001
001/001
002/005
002/005
002/005
001/005
001/005
001/005
001/005
001/005
001/005

TARAWEANG
TARAWEANG
TARAWEANG
BULU SIPONG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG
TARAWEANG

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

05/02/1991

08-04-1975

13-04-1995

05-02-1961

30-12-1983

12-01-1990
31-12-1991
30-11-1970
20-06-1976
09-06-1994
23-02-1996
15-04-1998
03-06-1955
02-02-1959
07-10-1968
16-02-1984
17-05-1995
31-12-1975
05-12-1980
01-04-1997
03-04-1970
31-12-1959
10-09-1980
01-03-1988
07-02-1987
26-01-1958
05-07-1967
04-07-1988
19-04-1990

B
B
S
S
B
B
B
P
S
S
B
B
S
S
B
P
P
B
B
B
S
S
S
B

03-03-1997
01/07/1983
02-02-1974
20-07-2009
21-04-1952
07-11-1951
01-12-1970
19-08-1978
11-03-1983
04-04-1984
30-12-1965
18-08-1971
15-11-1970
15-08-2985
14-06-1967
03-09-1986
10-12-1968
06-06-1985
23-05-1991
04-07-1976
17-02-1977
17-10-1990
08-04-1978
30-12-1993
17-08-1995
10-08-1993
10-11-1976
10-07-1986
10-12-1977
16-08-1969
19-10-1975
04-08-1978
15-07-1966
21-03-1985
30-05-1995
07-07-1970
10-08-1976
01-07-1977
11-04-1988
04-06-1970
08-08-1984
03-06-1967
05-05-1978
05-04-1943
23-11-1950

B
S
S
B
P
S
B
B
B
S
S
S
S
B
S
S
P
S
B
S
S
S
S
B
S
B
S
S
S
S
S
S
S
S
S
S
S
S
B
S
S
S
S
S
S

20-09-1966
28-05-1990
02-07-1972
06-07-1976
26-06-1996
01-12-1951
05-12-1960
21-09-1981
12-05-1985
20-04-1993
28-06-1998

B
B
S
S
B
S
S
P
B
B
B

ISIAN SURAT
PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa
b. Kecamatan

BARABATU
: LABAKKANG

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

NISA

7310074506590003

SAENI PADE

7310071208750001

SUMIATI

7310074610840003

MIDA

7310076007500002

ANTO

7310070801890001

TAJUDDIN
BURAHAN
ABD. RAHMAN B
IRA
SRY WULANDARI
SRY SUNDARI
BADDOLO
ROSI
ERLIS
ARJUN
DULLAH
KE'NANG
NORMA
TAHIR
SITA
MUHLIS
MELLY
CAMMA
GANDI
KAMARIA
RAHMA
AMBO TANG
NURUNG
ANDI

7310070107900365
7310070603920001
7310070301780001
7310074107800372
7310076303970002
7310075412980001
7310073112440007
7310076707600007
7310070702930001
7310072512973003
7310070156800002
7310074107750380
7310075709940002
7310071010770002
7310074703790001
7310070906950002
7310076807970302
7310077112390015
7310071211860002
7310074301900002
7310075710920001
7310071807690001
7310075708700001
7310070511940002

L
L
L
P
P
P
L
P
P
L
L
P
P
L
P
L
P
P
L
P
P
L
P
L

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

BAHRI
COLLE
SIA
MAJI
ABDUL KADIR
TAHYIB
SYAMSUDDIN
SYAMSINAR
RIZAl
TAHIR
PAHA
NAING
INDO TANG
PIASSE
BOKO
JUMRIAH
DANA
MARKUS
SRIPUSPITA
MARFIADI
ASRIDEVI
SANDY SAPUTRA
SAMSIA
A MULIADI ARIS
BAKKA
KAMU
RISMAWATI
SAPRI
RAMALANG
ABDUL MALIK
MO'MI

7310071106730001
7310070306360001
7310074608600001
7310070709790001
7310071710850001
7310070602620010
7310070911900003
7310075510950004
7310073110970001
7310071010770002
7310070508580009
7310071210660001
7310075002670001
7310063112840026
7310070106670002
7310074606660032
7310077112890019
7310072802670001
7310077112750001
7310072107920003
7310074609940001
7310070503950032
7310074107760348
7310070505740007
7310070104350002
7310075207400002
7310076106750001
7310073112730047
7310074107810282
7310070608680020
7310074107710185

L
L
P
L
L
L
L
P
L
L
L
L
P
L
L
P
P
L
P
L
P
L
P
L
L
P
P
L
P
L
P

PENDAFTARAN

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

KAMPUNG BARU

001/003

GATTA-GATTARENG

KAMPUNG BARU

001/003

KAMPUNG BARU

KAMPUNG BARU

001/003

KAMPUNG BARU

KAMPUNG BARU

001/002

KAMPUNG BARU

KAMPUNG BARU

001/002

BARA BATU

KAMPUNG BARU
KAMPUNG BARU
BARA BATU
BARA BATU
BARA BATU
BARA BATU
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
KALAMESUE
KALAMESUE
KALAMESUE
KALAMESUE
KALAMESUE
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
KAMPUNG BARU
KAMPUNG BARU
KAMPUNG BARU

001/002
001/002
002/002
002/002
002/002
002/002
002/002
002/002
002/002
002/002
002/001
002/001
002/001
002/001
002/001
002/002
002/002
002/002
002/002
002/002
002/002
001/001
001/001
001/001

BARA BATU
BARA BATU
LABBAKANG
JENNAE
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
LABBAKANG
LABBAKANG
KALAMESUE
TARAWEANG
KALAMESUE
TARAWEANG
KALAMESUE
BULU SIPONG
BULU SIPONG
LABBAKANG
BULU SIPONG
BULU SIPONG
BULU SIPONG
KAMPUNG BARU
KAMPUNG BARU
BARA BATU

KAMPUNG BARU
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
KALAMESUE
KAMPUNG BARU
BARA BATU
BARA BATU
KAMPUNG BARU
B. SIPONG DS BATU BATU
B. SIPONG DS BATU BATU
B. SIPONG DS BATU BATU
KAMPUNG BARU
KAMPUNG BARU
KAMPUNG BARU
KAMPUNG BARU
KAMPUNG BARU
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
BULU SIPONG
KALAMESUE
KALAMESUE
BULU SIPONG
BULU SIPONG

001/001
002/002
002/002
002/002
002/002
001/001
001/001
001/001
001/001
002/001
001/003
001/003
001/003
002/001
001/002
001/002
001/002
002/001
002/001
002/001
002/001
002/001
001/002
001/002
001/002
001/002
001/002
001/002
001/002
00/002
00/002

KAMP. BARU BARA

BULU SIPONG
BULU SIPONG
BULU SIPONG
LABBAKANG
NUSA TENGGARA TIMUR
NUSA TENGGARA TIMUR
NUSA TENGGARA TIMUR
NUSA TENGGARA TIMUR
TARAWEANG
BARA BATU
MAROS
BARA BATU
SELA
BULU SIPONG
BULU SIPONG
BULU SIPONG
UJUNG PANDANG
WAJO
WAJO
WAJO
WAJO
BULU SIPONG
LABBAKANG
TARAWEANG
TARAWEANG
TARAWEANG
KALAMESUE
TALAKA
TEPPOE
BULU SIPONG

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

05-06-1959

12-08-1975

06-10-1984

20-07-1950

08-01-1989

01-07-1990
06-03-1992
03-01-1976
01-07-1980
23-03-1997
14-12-1998
31-12-1944
27-07-1960
07-02-1993
25-12-1997
01-06-1968
01-07-1975
17-09-1994
10-10-1977
07-03-1979
09-06-1995
28-07-1997
31-12-1939
12-11-1986
03-01-1990
07-10-1992
18-07-1969
17-08-1970
05-11-1994

B
B
S
S
B
B
S
S
B
B
S
S
B
S
S
B
B
P
B
B
B
S
S
B

11-06-1973
03-06-1963
06-08-1960
07-09-1979
17-10-1985
06-02-1962
09-11-1990
15-10-1995
31-10-1997
10-10-1977
05-08-1958
12-10-1966
10-02-1967
31-12-1984
01-06-1967
06-06-1966
31-12-1989
28-03-1967
31-12-1975
21-07-1992
06-09-1994
05-03-1995
01-07-1976
05-05-1974
01-04-1935
12-07-1940
21-06-1975
31-12-1973
01-07-1981
06-06-1968
01-07-1971

B
S
S
S
B
S
B
B
B
S
S
S
S
S
S
S
B
S
S
B
B
B
B
S
S
S
S
S
S
S
S

ISIAN SURAT
PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa
b. Kecamatan

PUNDATA BAJI
: LABAKKANG

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

KURYADI

7310071010870008

ANDI M. ZATRIA AP

7310070308940001

AHMAD SANTA

7310071004710001

ST. RAHMA

7310075705620001

M. ARIF

7310070505580005

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

MURNI

7310076105850001

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

PENDAFTARAN

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

ERASA

002/001

PALOPO

MACCINI BAJI

003/004`

BAU BAU

ERASA

001/001

BATTO

MACCINI BAJI

003/004

BAU BAU

MACCINI BAJI

003/004

LABAKKANG

MARICAYYA

001/002

PUNDATA

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

10-10-1987

03-08-1994

10-04-1971

17-05-1962

05-05-1958

21-05-1985

ISIAN SURAT
PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa

b. Kecamatan

BONTOMANAI
:

LABAKKANG

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

MUHAMMAD JOHAN

7310071502910003

NURDIN

7310073112600045

RUGAYYA

7310073112600045

MUH. SYARIEF

7310071905920001

SANGKALA

7310070704930001

AGUSTINA
RAMLI
RATNA
HASBIAH
RIDWAN
TAMRIN
ERNI
M. ILHAM DG TEPPO
ASHARI
ABD. RAHMAN MUSO
IDA WAHYUNI
MARWAH
AMIRUDDIN
KAMARUDDIN HR
RISNAWATI
M. DG. MILE
SAMUNA
HAYATI
TOLA
MATIA
JUMANIA
HUSBA
SIRA
MUH. YUSUF

7310075708980004
7310073112760052
7310074606800006
7310074309610001
7310070306920001
7310070109740005
7310074508940006
7310070304770003
7310076807850001
7310072509790004
7310075711830001
7310074112620002
7310072510880001
7310071708800007
7310074107900383
7310073007600001
7310074107590077
7310074107840290
7310070107900371
7310074117920359
7310074107940335
7310072912580002
7310077112640026
7310070507780003

P
L
P
P
L
L
P
L
P
L
P
P
L
L
P
L
P
P
L
P
P
L
P
P

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

ILMAYANI
NUR LINA
FITRIANI
HALWANI
HJ NAJO
PAISAL
SUNGGU
P DG. KANANG
ABD KADIR
HASNA
MAHMUD Y
MANNENG
AMIR M
FATMAWATI
H. DH. SIALA
H DG BOLLO
ROHANA
KAHARUDDIN
UMAR DG LAJA
MARAWA
SYAMSUL RIJAL
SYAMSUL RISAL
NONGKO
RUGA
JUMA
JAMILA
HASMAWATI

7310075306870001
7310075501920006
7310076110970002
7310074099750002
7310074107330268
7310071601680001
7310074107710184
7310076106550001
7310071808790003
7310075906810004
7310071507650006
7310077112700041
7310071910850004
7310074706900003
7310070106610015
7310077112630046
7310075212920005
7310070503930002
7310070607700001
7310075312770001
7310070906920001
7310073107970001
7310073112580009
7310074508750006
7310073112500032
7310074112600003
7310077110900001

P
P
P
P
P
L
P
P
L
P
L
P
L
P
L
P
P
L
L
P
L
L
L
P
L
P
P

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

KP CAMPAGA

002/004

CAMPAGA

KP SEKOA

2/1

SEKOA

KP SEKOA

2/1

TEKO

KP SEKOA

2/1

LABAKKANG

KP SEKOA

2/1

SEKOA

KP SEKOA
KP DERA
KP DERA
TANARAJAE
TANARAJAE
BINANGATOA
BINANGATOA
KP MATTOANGIN
KP MATTOANGIN
BINANGATOA
BINANGATOA
KP MATTOANGIN
KP MATTOANGIN
KP DERA
KP DERA
TANARAJAE
BANGKALA
BANGKALA
BANGKALA
BANGKALA
BANGKALA
KP MATTOANGIN
KP MATTOANGIN
KP MATTOANGIN

2/1
005/001
005/001
003/005
003/005
001/005
001/005
004/002
004/002
002/005
002/005
002/003
002/003
001/003
001/003
003/005
001/002
001/002
001/002
001/002
001/002
001/004
001/004
001/004

TEKO
DERA
MANDALLE
TANARAJAE
PAMMENREKANG
TANARAJAE
PANJAMMA
KALUKUA
MATTOANGIN
LABAKKANG
LABAKKANG
MATTOANGIN
LABAKKANG
LABAKKANG
MAROS
PULAU SAKUALA
BANGKALA
BANGKALA
BANGKALA
BANGKALA
BANGKALA
MATTOANGIN
MATTOANGIN
MATTOANGIN

KP MATTOANGIN
KP MATTOANGIN
KP MATTOANGIN
KP DERA
KP SEKOA
KP MATTOANGIN
KP MATTOANGIN
TANARAJAE
TANARAJAE
TANARAJAE
BINANGATOA
BINANGATOA
BINANGATOA
BINANGATOA
DERA
DERA
DERA
DERA
KP MATTOANGIN
KP MATTOANGIN
KP MATTOANGIN
KP MATTOANGIN
BANGKALA
BANGKALA
BONTO MANAI
BONTO MANAI
BONTO MANAI

001/004
001/004
001/004
001/003
003/001
001/004
001/004
003/005
003/005
003/005
002/005
002/005
002/005
002/005
001/003
001/003
001/003
001/003
002/003
002/003
002/003
002/003
002/002
002/002
002/004
002/004
002/004

LABAKKANG
LABAKKANG
LABAKKANG
DERA
DERA
PANGKEP
DERA
PULAU SAKUALA
TANARAJAE
TANARAJAE
BINANGATOA
BINANGATOA
LABAKKANG
LABAKKANG
DERA
DERA
DERA
DERA
PANGKEP
BONTOWA
BONTOWA
BONTOWA
BONTO SUNGGU
BANGKALA
BONTO MANAI
PANGKEP
LABAKKANG

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

04-01-1940

31-12-1960

03-05-1966

19-05-1992

07-04-1993

17-08-1998
31-12-1976
05-05-1980
03-09-1961
03-06-1992
01-09-1974
05-06-1994
03-04-1977
28-07-1985
25-09-1979
17-11-1983
01-12-1962
25-10-1988
17-08-1980
01-07-1990
30-07-1950
01-07-1959
01-07-1984
01-07-1990
01-07-1992
01-07-1994
29-12-1958
31-12-1964
05-07-1978

B
S
S
P
B
S
S
S
S
S
S
S
S
S
S
S
S
B
B
B
B
S
S
B

13-06-1987
15-01-1992
11-10-1997
09-09-1975
01-07-1933
16-01-1968
01-07-1971
21-06-1955
18-08-1979
19-06-1981
15-07-1965
31-12-1970
19-10-1985
07-06-1990
01-06-1961
31-12-1963
12-12-1992
05-03-1993
06-07-1970
13-12-1977
09-061992
31-07-1997
31-12-1958
05-06-1975
31-12-1950
01-12-1960
31-10-1990

S
B
B
P
P
S
S
S
S
S
S
S
B
B
S
S
B
B
S
S
B
B
S
S
S
S
B

ISIAN SURAT
PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa
b. Kecamatan

MANAKKU
:

LABAKKANG

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

YULIANTI

7310076507850001

JAYA ANTON

7310070108820003

TASMI

7310076312870003

MUH IDRIS

7310070811860006

MAHMUD

7310070708450004

JUMRIAH
KUDSIAH
RISNAWATI
H. DG SUJI
S DG SANGING
N DG LABBI
J DG TANGGNGA
YUPO
LAKADI
NURSIA
KAMARUDDIN
NURHAYATI
YUDU
ISMAIL
RITA
SITTI
NURBAYA
JUMA
NURBAYA
MIHANI
H M DG TEPPO
HJ P DG SUNGGU
J DG PUJI
M N DG LIBU

7310077012590005
7310074810690003
7310074904980004
7310076104460002
7310075002790003
7310074302760002
7310070303760003
7310075008460001
7310070503440001
7310077112800007
7310072105780003
7310077112890011
7310070111620001
7310071404960002
7310075507850007
7310075127450001
7310076105930002
7310072503430002
7310074911590001
7310070307660001
7310073112400032
7310077103840001
7310075109810002
7310070607760002

P
P
P
P
P
P
P
P
L
P
L
P
L
L
P
L
P
L
P
P
L
P
P
L

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74

HABIBIA
SIA
ITENG DG TENE
H DG SIGA
FIRMAN
NAJHA
MUH IDRIS
BALIANA
MUSDALIFA IDRIS
BAHARUDDIN
RAMLAH
LINA
MASO
BOLLENG
HJ SAHARI
SYAMSUDDIN
NASRUL
HJ KATI
MASATI
NUR'AIDA
RUKMINI
MUSTAFA
JUMRIA
ZAENAL
IDO
HASNIATI
ROHATI
BAHRA
NURDIN
JAMALUDDIN
HASAN
SYAMRIANI
M DG ROLA
HADI
MALIAS DG TOBO
HAMSIAH
H SAING
HJ SANGNGING
SAKKA
MAEGA
HJ HASNAH
AGUSTIA
HALUA
DEDDY
KAINUDDIN

7310075708450003
7310070505490001
7310077112530033
7310071011730002
7310070306810002
7310076109800002
7310070607760003
7310073112800038
7310070510595003
7310072911820001
7310075503860003
7310074211600001
7310076109750001
7310073112550027
7310077112570021
7310073112880046
7310071210930002
7310074809620002
7310075210650005
7310076504690001
7310075103910005
7310072009560001
7310075711520001
7310071801930001
7310073012820009
7310075510880006
7310074903720001
7310074708730001
7310071510790003
7310070810830004
7310072301930001
7310076809750002
7310070506750008
7310074202820005
7310073112810029
7310074908870001
7310071505250001
7310075108360001
7310077112660040
7310075010730002
7310074504540010
7310076302870002
7310074611600001
7310070107880411
7310071112580001

P
L
L
P
L
P
L
P
P
L
P
P
L
L
P
L
L
P
P
P
P
L
P
L
L
P
P
L
L
L
L
P
L
P
L
P
L
P
P
P
P
P
P
L
L

75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104

RUKIAH
BAHARUDDIN
ROSNA
ABBAS DG NGEWA
HASBIAH DG NILLANG
RIMANG
KULLE
HJ DG NOTTA
Y DG TENE
BADA
NAJO
CORA
HAERUDDIN
HASMIATI
ILYAS
HESNIATI
GAPPA
SINGARA
KALLANG
TANCU
SAHARUDDIN
BAHARUDDIN
SALARUDDIN
MARUDDANI
NABA
PAJJA
ATOM DG BETA

7310076708590001
7310073112790052
7310077112810033
7310070907700003
7310075206750003
7310075410370001
7310071611660001
7310075008540001
7310070278460001
7310075308310001
7310071125510002
7310077112570003
7310078056750003
7310076227770001
7310073112780031
7310074709760002
7310071011660005
7310074905730001
7310077112490017
7310070307800002
7310071305800005
7310073001820001
7310071712750002
7310071007870005
7310071208870001
7310075212880005
7310071007670001

P
L
P
L
P
P
L
P
P
P
L
P
L
P
L
P
L
P
P
L
L
L
L
L
L
P
L

NDAFTARAN

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

KP TEKO

001/002

KANAUNGAN

KP TEKO

001/002

LABAKKANG

KP TOGGOLO

001/002

TAMANG ROJA

KP TOGGOLO

001/002

LABAKKANG

KP PAMMENREKANG

001/001

LABAKKANG

KP PAMMENREKANG
KP TONASA
KP TONASA
TONASA
TONASA
KP TONASA
KP TONASA
LASSANG
LASSANG
KP PAMMENREKANG
KP PAMMENREKANG
KP TONASA
KP TONASA
KP TONASA
KP PAMMENREKANG
KP RONGGOLO
KP KOKOA
KP KOKOA
KP TOGGOLO
KP TOGGOLO
KP BONTO ALI
KP BONTO ALI
KP PAMMENREKANG
KP PAMMENREKANG

001/001
001/002
001/002
001/002
001/002
002/001
002/001
001/001
001/001
002/002
002/002
002/001
002/001
002/001
001/001
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/001
001/001

LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
BONTO BONTO
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
PANGKEP

KP KOKOA
KP KOKOA
TONASA
TONASA
PAMMEREKANG
PAMMEREKANG
KP KOKOA
KP KOKOA
KP KOKOA
TONASA
KP KOKOA
KOKCA
KOKCA
LASSANG
LASSANG
LASSANG
LASSANG
KP TEKO
KP TEKO
KP TEKO
KP TEKO
TEKO
TEKO
TEKO
KP KOKOA
KP KOKOA
KP SAPPAYYA
KP SAPPAYYA
KP SAPPAYYA
KP SAPPAYYA
KP SAPPAYYA
KP TEKO
TEKO
TEKO
KP TONASA
KP TONASA
KP BULOA
KP BULOA
KP KOKOA
KP KOKOA
KP TEKO
KP TEKO
KP PAMMENREKANG
KP PAMMENREKANG
KP TONASA

001/002
001/002
001/001
001/001
002/001
002/001
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/001
001/001
001/001
001/001
002/001
002/001
001/002
001/002
002/001
002/001
002/001
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/002
001/001
001/001
001/001
001/001
001/002
001/002
002/002
002/002
005/003

KOKOA
KOKOA
LABAKKANG
LABAKKANG
PUNDATA
PUNDATA
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
PANGKEP
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
TEKO
LABAKKANG
BATILING
KAJUJAWAYYA
LABAKKANG
LABAKKANG
LABAKKANG
KOKOA
KOKOA
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG

KP TONASA
PAMMEREKANG
PAMMEREKANG
LASSANG
LASSANG
KP SAPPAYYA
KP PAUKIRI
KP TONASA
TONASA
BONTOLALI
KP PAMMENREKANG
KP PAMMENREKANG
KP SAPPAYYA
KP SAPPAYYA
KP PAMMENREKANG
KP PAMMENREKANG
KP PAMMENREKANG
KP PAMMENREKANG
PAMMEREKANG
PAMMEREKANG
PAMMEREKANG
PAMMEREKANG
PAMMEREKANG
PAMMEREKANG
KP KOKOA
KP KOKOA
PAMMEREKANG

005/003
003/002
003/002
1/1
1/1
001/002
001/002
001/002
001/002
002/001
002/002
002/002
001/001
001/001
002/002
002/002
002/001
002/001
002/002
002/002
002/002
002/002
002/002
002/002
001/002
001/002
2/1

LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
MACINNA
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
LABAKKANG
KOKOA
KOKOA
LABAKKANG

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

25-07-1985

01-03-1983

23-12-1987

08-11-1985

07-08-1945

30-12-1959
08-10-1969
09-04-1998
21-04-1946
10-01-1979
03-02-1976
03-03-1976
10-06-1946
05-03-1944
31-12-1980
21-05-1978
31-12-1989
01-11-1962
14-04-1996
15-07-1985
12-07-1946
21-05-1993
25-03-1943
09-11-1959
23-07-1966
31-12-1940
31-03-1984
10-09-1981
06-07-1976

S
B
B
P
P
S
S
S
S
S
S
S
S
B
S
P
B
P
B
B
S
S
S
S

17-08-1945
25-05-1940
31-12-1953
10-11-1973
03-05-1981
11-09-1980
06-07-1976
31-12-1980
10-05-1995
29-11-1982
15-03-1986
15-04-1951
21-09-1975
31-12-1955
31-12-1957
31-12-1988
12-10-1993
08-09-1962
12-10-1965
15-04-1969
11-03-1991
20-09-1956
17-11-1962
18-11-1993
30-12-1982
15-10-1988
09-03-1972
07-08-1973
15-10-1979
08-10-1983
23-01-1993
28-09-1975
05-06-1975
02-02-1982
31-12-1981
09-08-1987
15-05-1952
11-08-1930
31-12-1966
10-07-1930
05-04-1954
23-02-1987
06-11-1960
01-07-1988
11-12-1958

S
S
S
S
S
S
S
S
B
B
B
S
B
B
B
B
B
B
B
P
B
S
S
B
S
S
B
B
B
B
B
S
S
S
S
S
S
S
B
B
P
B
P
B
S

27-08-1959
31-12-1979
31-12-1981
09-07-1970
12-06-1975
14-10-1937
16-11-1966
10-08-1954
27-08-1946
13-08-1931
01-12-1951
31-12-1957
05-06-1975
22-07-1977
13-12-1978
07-09-1976
10-11-1966
05-05-1973
31-12-1949
03-02-1978
13-05-1980
30-01-1982
17-12-1985
10-07-1987
12-08-1987
12-12-1988
10-07-1967

S
S
S
S
S
S
S
P
S
P
S
S
S
S
S
S
S
S
P
B
B
B
B
B
S
S
S

ISIAN SURAT
PERNYATAAN
DUKUNGAN DAN DOKUMEN PENDAFTARAN
PASANGAN
CALON
PERSEORANGAN
(sebagai isian untuk Formulir Model B.1-KWK PERSEORANGAN)

INFORMASI WILAYAH
a. Kelurahan/Desa
b. Kecamatan

MANGALEKANA
: LABAKKANG

DATA PENDUKUNG
No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29

Nama

NIK

Jns Kelamin

30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

PENDAFTARAN

Kabupaten/Kota

Provinsi

PANGKEP
SUL - SEL

Alamat

RT/RW

Tempat Lahir

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

DATA PENDUKUNG
No

Nama

NIK

Jns Kelamin

MARDIANTO1

1234567890123456

MARDIANTO2

1234567890123456

MARDIANTO3

1234567890123456

MARDIANTO4

1234567890123456

MARDIANTO5

1234567890123456

MARDIANTO6
MARDIANTO7
MARDIANTO8
MARDIANTO9
MARDIANTO10
MARDIANTO
MARDIANTO
MARDIANTO
MARDIANTO
MARDIANTO

1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456

L
L
L
L
L
L
L
L
L
L

6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40

41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73

Alamat

RT/RW

Tempat Lahir

KURIPAN RAYA

01/02

BOYOLALI

KURIPAN RAYA

01/02

BOYOLALI

KURIPAN RAYA

01/02

BOYOLALI

KURIPAN RAYA

01/02

BOYOLALI

KURIPAN RAYA

01/02

BOYOLALI

KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN

01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02

BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI

RAYA
RAYA
RAYA
RAYA
RAYA
RAYA
RAYA
RAYA
RAYA
RAYA

Tanggal Lahir
8

Belum/Pernah/
Sudah Kawin
9

28/12/1988

28/12/1988

28/12/1988

28/12/1988

28/12/1988

28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988

B
B
B
B
B
B
B
B
B
B

aba
abb
abc
abd
abe
abf
abg
abh
abi
No

Nama

MARDIANTO1

MARDIANTO2

MARDIANTO3

MARDIANTO4

MARDIANTO5

6
7
8
9
10
11
12
13
14
15

MARDIANTO6
MARDIANTO7
MARDIANTO8
MARDIANTO9
MARDIANTO10
MARDIANTO
MARDIANTO
MARDIANTO
MARDIANTO
MARDIANTO

NIK

Jns Kelamin Alamat

RT/RW

1234567890123456

KURIPAN RA

01/02

1234567890123456

KURIPAN RA

01/02

1234567890123456

KURIPAN RA

01/02

1234567890123456

KURIPAN RA

01/02

1234567890123456

KURIPAN RA

01/02

1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456

L
L
L
L
L
L
L
L
L
L

KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN
KURIPAN

01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02

RA
RA
RA
RA
RA
RA
RA
RA
RA
RA

Tempat Lahir

Tanggal Lahir

Belum/Pernah/
Sudah Kawin

BOYOLALI

28/12/1988

BOYOLALI

28/12/1988

BOYOLALI

28/12/1988

BOYOLALI

28/12/1988

BOYOLALI

28/12/1988

BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI

28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988
28/12/1988

B
B
B
B
B
B
B
B
B
B

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21

NAMA
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI
BUDI

NIK
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222
122222

JNSKELAMI
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L
L

ALAMAT
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN
MARSIAN

RTRW
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan
2-Jan

TPTLAHIR
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG
BOJONG

TGLLAHIR STATUS
28/12/1961B
28/12/1961B
28/12/1961B
28/12/1961B
28/12/1961B
28/12/1961B
28/12/1961B
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961
28/12/1961

No

Nama

1
2
3
4
5
6
7
8
9
10

2
MARDIANTO1
MARDIANTO2
MARDIANTO3
MARDIANTO4
MARDIANTO5
MARDIANTO6
MARDIANTO7
MARDIANTO8
MARDIANTO9
MARDIANTO10

NIK
3
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456
1234567890123456

Jns Kelamin
4
L
L
L
L
L
L
L
L
L
L

Alamat
5
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA
KURIPAN RAYA

RT/RW Tempat Lahir Tanggal Lahir

6
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02
01/02

7
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI
BOYOLALI

8
28/12/1988
28/12/1988
28-12-1988
28-12-1988
28-12-1988
28-12-1988
12/28/1998
12/28/1998
1998/12/28
1998/12/28

Belum/Perna
h/
Sudah9Kawin
B
B
B
B
B
B
B
B
B
B