60.4.1. Form Pengaduan Masyarakat

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60.4.1. Form Pengaduan Masyarakat

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PENGADILAN AGAMA AMUNTAI

No. Tgl. Tgl. Tgl.

FM/AP/60/04 04-09-2017 - 05-09-2017
Dokumen : Pembuatan : Revisi : Efektif :

FORMULIR PENGADUAN MASYARAKAT

Yang bertanda tangan di bawah ini
Nama : ...........................................................................
Alamat : ...........................................................................
No. Telp : ...........................................................................
Pekerjaan : ...........................................................................

Dengan ini bermaksud mengadukan hal-hal sebagai berikut :

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Amuntai, ……………………………..
Pelapor,
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