: 006 KAB/KOTA 1)

: CIOMAS PROVINSI

: PANJALU Halaman

PEMILIH KARTU KELUARGA TEMPAT TANGGAL L P ALAMAT RT RW DUSUN

1 3 5 6 7 8 10

1 3207085209340001 3207080212080002 TITI CIAMIS 12-09-1934 78 P P DUSUN CIOMASLANDEUH019 009 CIOMASLANDEUH

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19 3207082602620001 3207081608070233 DANA RAMDANI CIAMIS 26-02-1962 50 S L CIOMAS LANDEUH 019 009 CIOMAS LANDEUH

NO. URUTNOMOR PEMILIH JENIS KELAMIN ALAMAT/TEMPAT TINGGAL

DAFTAR PEMILIH TETAP

PEMILIHAN GUBERNUR DAN WAKIL GUBERNUR JAWA BARAT

TAHUN 2013

MODEL A3 - KWK.KPU

TPS

DESA/KELUARAHAN 1)

KECAMATAN

: CIAMIS

: JAWA BARAT

: ...

9

KETERANGAN 2)

2

NAMA PEMILIHTEMPAT DAN TANGGAL LAHIR

4

UMUR/USIASTATUS PERKAWINAN (B/S/P)

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256 3207084207350001 3207081708070115 CICIH CIAMIS 02-07-1935 77 S P CIOMAS LANDEUH 021 009 CIOMAS LANDEUH

257 3207082502660001 3207081708070116 UKIM CIAMIS 25-02-1966 46 S L CIOMAS LANDEUH 021 009 CIOMAS LANDEUH

258 3207084406710001 3207081708070116 TETI CIAMIS 04-06-1971 41 S P CIOMAS LANDEUH 021 009 CIOMAS LANDEUH

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289 3207085503930003 3207082010100002 RIAN NURYANTI CIAMIS 15-03-1993 19 S P CIOMAS LANDEUH 021 009 CIOMAS LANDEUH

290 3207081503870003 3207082106100005 BUDIYAWAN BANDUNG 15-03-1987 25 S L CIOMASLANDEUH 021 009 CIOMASLANDEUH

291 3207084208880001 3207082106100005 MARIA AGUSTINA CIAMIS 02-08-1988 24 S P CIOMASLANDEUH 021 009 CIOMASLANDEUH

292 3207082003940001 3207082202110074 DODI ROHWANDI CIAMIS 20-03-1994 18 B L CIOMAS LANDEUH 021 009 -

293 3207084302750001 3207082202110074 MOMOH HALIMAH CIAMIS 03-02-1975 38 P P CIOMAS LANDEUH 021 009 -

294 3207082303870001 3207082307120002 DANI HAMDANI CIAMIS 23-03-1987 25 S L CIOMAS LANDEUH 021 009 -

295 3207086009910001 3207082307120002 MAYA ULPAH HIDAYAT CIAMIS 20-09-1991 21 S P CIOMAS LANDEUH 021 009 -

296 3207086802660002 3207082806120001 ADAH SITI SHOIDAH CIAMIS 28-02-1966 46 P P CIOMASLANDEUH 020 009 CIOMASLANDEUHTAMBAHAN |

Nama Tanda Tangan

1. Ketua ADE LUAY ISKANDAR, S.Ag ..............

2. Anggota SUBHAN FIRDAUS, S.Ag ..............

3. Anggota GUGUH RISNA GUNAWAN, S.Pd ..............

2) = Cacat yang disandang pemilih kalau ada

Catatan:

Status Perkainan:

B = Belum nikah

S = Sudah nikah

............., ...............

Disahkan dalam Rapat Pleno PPS Tanggal ......

PANITIA PEMUNGUTAN SUARA

P = Pernah nikah

Jenis Kelamin:

Lk = Laki-laki

Pr = Perempuan

1) = Coret yang tidak perlu

DUSUN CIOMAS LANDEUH

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