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PEMERINTAHAN
KABUPATEN KEBUMEN
KECAMATAN AYAH
DESA CANDIRENGGO
Jalan
Raya Pantai Logending Km 3 Nomor 13 Kode Pos 54473
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DAFTAR
HADIR
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Hari
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:
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Tanggal
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Waktu
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Tempat
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.....................................................................................................
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Acara
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.....................................................................................................
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.....................................................................................................
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NO
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N A M A
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UNSUR
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TANDA TANGAN
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1
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4
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KEPALA DESA CANDIRENGGO
ADY WALUYO
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