BADAN PERMUSYAWATAN DESA PAKALONGAN BADAN PERMUSYAWATAN DESA PAKALONGAN

KECAMATAN SODONGHILIR KECAMATAN SODONGHILIR

KABUPATEN TASIKMALAYA KABUPATEN TASIKMALAYA
Jl. Pakalongan RT 001 RW 001 Desa Pakalongan Kecamatan Sodonghilir Kabupaten Tasikmalaya Jl. Pakalongan RT 001 RW 001 Desa Pakalongan Kecamatan Sodonghilir Kabupaten Tasikmalaya
46473 EMAIL : bpddesapakalongan@gmail.com 46473 EMAIL : bpddesapakalongan@gmail.com

Yang bertanda tangan di bawah ini : Yang bertanda tangan di bawah ini :

Nama :............................................................... Nama :...............................................................

Pekerjaan :............................................................... Pekerjaan :...............................................................
Alamat :............................................................... Alamat :...............................................................
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Ditujukan Kepada :............................................................... Ditujukan Kepada :...............................................................

Dengan ini saya memberikan usulan / gagasan / pernyataan / saran / Kritik dengan penuh Dengan ini saya memberikan usulan / gagasan / pernyataan / saran / Kritik dengan penuh
tanggung jawab, adapaun hal yang ingin saya sampaikan adalah : tanggung jawab, adapaun hal yang ingin saya sampaikan adalah :

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Demikian hal ini saya sampaikan, atas segala perhatian saya ucapkan terima kasih Demikian hal ini saya sampaikan, atas segala perhatian saya ucapkan terima kasih
Pakalongan.................,.......................,2021 Pakalongan.................,.......................,2021
Hormat Saya Hormat Saya

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