Surat Pernyataan

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  SURAT PERNYATAAN  Yang bertanda tangan dibawah ini :N a m a:FERAWATI R MARIADJANG Tempat Tanggal Lahir:Bati! # Febrari $%&&'endidi(an ) Jr*an:+$),(mAlamat:De*a Lampa -e./ Banggai -abpaten Banggai LatDengan ini men0ata(an bahwa *etelah *a0a di ang(at men1adi 2al3n 'egawaiNegeri +ipil Daerah -abpaten Banggai Lat Tahn Anggaran 4 $5! ma(a *a0aber*edia nt( tida( pindah (elar wila0ah (er1a 'emerintah daerah -abpatenBanggai Lat paling (rang *elama $ 6+eplh7 Tahn/Demi(ian *rat pern0ataan ini dibat dengan *e*ngghn0a tanpa ada pa(*aandari piha( manapn! dan apabila di(emdian hari tern0ata pern0ataan ini tida(benar ma(a *a0a ber*edia di tntt di depan pengadilan/Banggai! 8 +eptember 4 $5 Yang membat 'ern0ataanFERAWATI R MARIADJANG  BANGGAI! 8 +E'TEMBER 4 $5-E'ADA'ERI,AL : 'ERM9,9NAN 'ENGANG-ATAN YT,/ BA'A- B'ATI BANGGAILAT 2AL9N 'EGAWAI NEGERI +I'ILDI ; DAERA,BANGGAI YANG BERTANDA TANGAN DI BAWA, INI :NAMA:FERAWATI R MARIADJANG TEM'AT TANGGAL LA,IR:BATI! # FEBRARI $%&& JENI+ -ELAMIN:'EREM'ANAGAMA:I+LAM'ENDIDI-AN)JR+AN:+$),-M JABATAN YANG DI LAMAR:ADIT9R 'ERTAMAALAMAT:DE+A LAM'A -E2/ BANGGAI -AB'ATENBANGGAI LATN9M9R ,': &$4 5$4 <84 =5DENGAN INI MENGAJ-AN 'ERM9,9NAN -E,ADA'AN BA'A- -IRANYA+AYADA'AT DIANG-AT MENJADI 2AL9N 'EGAWAI NEGERI +I'IL DAERA, DI  'ENDIDI-AN:+$) ,-MNAMA JABATAN:ADIT9R'ERTAMA'ANITIA 'ENERIMAAN 2'N+ TA,N 4 $5'EMERINTA, -AB/ BANGGAI LATD)A BADAN -E'EGAWAIAN DAERA,-AB/ BANGGAI LAT JLN/ J9GG >A-ARIA N9/ $BANGGAI -AB/ BANGGAI LAT %5<%$FERAWATI R MARIADJANG JLN/ J9GG +9',IA DE+A LAM'A-E2/ BANGGAI -AB'ATEN BANGGAI LAT %5<%$
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