PERNYATAAN KEBERATAN ATAS PERMOHONAN INFORMAS
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A. INFORMASI PENGAJUAN KEBERATAN
Identitas Pemohon
Nama : *
Alamat : *
Pekerjaan : *
No Telp/ WA : *
Identitas Kuasa Pemohon
Nama : *
Alamat : *
No Telp/ WA : *
B. ALASAN KEBERATAN *
C. TAMBAHAN
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