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Surat ini adalah pendaftaran Dedi Heriyanto sebagai calon anggota PPS di Desa Tanjung Agung, Kecamatan Muko-Muko Bathin VII, Kabupaten Bungo untuk pemilihan umum tahun 2024 berdasarkan pengumuman seleksi KPU Kabupaten Bungo. Surat ini berisi identitas dan alamat Dedi serta lampiran dokumen administrasi yang dipersyaratkan UU Pemilu.

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SURAT PENDAFTARAN
SEBAGAI CALON ANGGOTA PPS
KABUPATEN BUNGO
UNTUK PEMILIHAN UMUM
TAHUN 2024
Yang bertanda tangan di bawah ini:
Nama : DEDI HERIYANTO, S.AB
Jenis Kelamin : LAKI-LAKI
Tempat Tgl. Lahir/Usia : TANJUNG AGUNG, 26-02-1987/35 Tahun
Pekerjaan/Jabatan : Karyawan Honorer/ KANTOR CAMAT MUKO
MUKO BATHIN VII
Alamat : DESA TANJUNG AGUNG,KECAMATAN MUKO
MUKO BATHIN VII KABUPATEN BUNGO
TANJUNG AGUNG, KEC. MUKO-MUKO BATHIN
VII, BUNGO
dengan ini mendaftarkan diri sebagai calon anggota PPS di Desa Tanjung Agung
berdasarkan Pengumuman Seleksi Calon Anggota PPS KPU Kabupaten Bungo
Nomor …… tanggal …………………….
Bersama ini dilampirkan dokumen persyaratan administrasi untuk memenuhi
ketentuan pasal 72 Undang-Undang Nomor 7 Tahun 2017 tentang Pemilihan
Umum.
Tanjung Agung, 27 December
2022
PENDAFTAR,
( DEDI HERIYANTO, S.AB )

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surat_pendaftaran_4a730jZG8MHRj02.docx

1. SURAT PENDAFTARAN SEBAGAI CALON ANGGOTA PPS KABUPATEN BUNGO UNTUK PEMILIHAN UMUM TAHUN 2024 Yang bertanda tangan di bawah ini: Nama : DEDI HERIYANTO, S.AB Jenis Kelamin : LAKI-LAKI Tempat Tgl. Lahir/Usia : TANJUNG AGUNG, 26-02-1987/35 Tahun Pekerjaan/Jabatan : Karyawan Honorer/ KANTOR CAMAT MUKO MUKO BATHIN VII Alamat : DESA TANJUNG AGUNG,KECAMATAN MUKO MUKO BATHIN VII KABUPATEN BUNGO TANJUNG AGUNG, KEC. MUKO-MUKO BATHIN VII, BUNGO dengan ini mendaftarkan diri sebagai calon anggota PPS di Desa Tanjung Agung berdasarkan Pengumuman Seleksi Calon Anggota PPS KPU Kabupaten Bungo Nomor …… tanggal ……………………. Bersama ini dilampirkan dokumen persyaratan administrasi untuk memenuhi ketentuan pasal 72 Undang-Undang Nomor 7 Tahun 2017 tentang Pemilihan Umum. Tanjung Agung, 27 December 2022 PENDAFTAR, ( DEDI HERIYANTO, S.AB )

surat_pendaftaran_4a730jZG8MHRj02.docx

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