tag:blogger.com,1999:blog-85447239098669816722024-02-06T18:42:10.123-08:00SURAT-SURAT TANAHAnonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.comBlogger33125tag:blogger.com,1999:blog-8544723909866981672.post-65664864448482239602015-12-20T02:15:00.002-08:002015-12-20T02:18:29.073-08:00SURAT PERNYATAAN BELI BERDASARKAN LUAS DAN BATAS TANAH<div align="center" class="MsoNoSpacing" style="line-height: 115%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">SURAT </span></u></b><b><u><span style="font-family: "bookman old style" , "serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">PERNYATAAN<o:p></o:p></span></u></b></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Kami yang</span><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> bertanda tangan dibawah ini</span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">:<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Nama : ISNAIDI<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">TTL : Lamongan, 05-11-1967<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Pekerjaan : Petani/Pekebun<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Alamat : Ds. Lukrejo, Kec. Kalitengah<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> LAMONGAN.<o:p></o:p></span></div>
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<span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Dengan ini menerangkan
bahwa:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">1.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Tanah yang saya beli berdasarkan alas
hak C. Desa Nomor 136, Persil 12, Blok I, An. Rumasih B. Kasemu, sudah pernah
dilakukan pengukuran oleh petugas ukur dari BPN.</span><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">2.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Pada saat pengukuran oleh petugas ukur
dari BPN pihak penjual (Nyonya RUMASIH) Juga ikut menyaksikan serta menunjukkan
patok batas yang dimaksud.</span><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l0 level1 lfo1; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">3.<span style="font-family: "times new roman"; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Tanah yang saya beli bukan berdasarkan
luas, akan tetapi berdasarkan patok batas tanah.</span><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Demikian
Surat Keterangan Penguasaan Tanah ini kami buat dengan benar untuk dipergunakan
sebagaimana mestinya.<o:p></o:p></span></div>
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<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 13.0cm;">
<span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Lamongan</span><span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">, tgl </span><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">27-10-2015<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 13.0cm;">
<span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> </span><b><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Yang Menyatakan<o:p></o:p></span></b></div>
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<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 13.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 13.0cm;">
<br /></div>
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<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 13.0cm;">
<span lang="EN-US" style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> </span><b><u><span style="font-family: "bookman old style" , "serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">I S N A I D I<o:p></o:p></span></u></b></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-59926032464861160322015-10-07T08:16:00.001-07:002015-10-07T08:16:11.284-07:00PENGECEKAN SERTIPIKAT<div class="MsoNormal" style="text-align: center;">
<b><u>Cek Sertipikat</u></b></div>
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Pada postingan kali ini,<o:p></o:p></div>
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<br /></div>
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Saya akan membahas tentang Pengecekan
Sertipikat.</div>
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adapun dokumen-dokumen yang disiapkan, antara lain:</div>
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<br /></div>
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<span style="font-stretch: normal; text-indent: -18pt;">1. </span><span style="font-size: 7pt; font-stretch: normal; text-indent: -18pt;"> </span><span dir="LTR" style="text-indent: -18pt;"></span><span style="text-indent: -18pt;">SPS (Surat Perintah Setor).</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">2. Pengantar Pengecekan dari
Notaris/PPAT.</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">3. Fc. KTP Notaris/PPAT.</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">4. Surat Kuasa dan Fc. KTP yang dikuasakan.</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">5. Fc. Kartu Tanda Penduduk
(KTP) + Kartu Keluarga (KK) Pemilik Sertipikat Hak Milik.</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">6. Setelah itu bawa ke loket
BPN setempat.</span></div>
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<span style="text-indent: -18pt;"><br /></span></div>
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<span style="text-indent: -18pt;">7. Tunggu 1 -2 hari tanyakan di
bagian loket/Pengambilan cek-cekan Sertipikat.</span></div>
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<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com1tag:blogger.com,1999:blog-8544723909866981672.post-80135225303960435612015-10-07T08:05:00.001-07:002015-10-07T08:05:46.710-07:00UTM AREA MEASURE<div style="text-align: center;">
<b>UTM AREA MEASURE</b></div>
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Pertama-tama agan download dulu di Play Store..</div>
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Lalu Coba kita jalankan deh Aplikasinya..</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj32joym13t51GJGppOnvDX-QbvMMeQDkxZpqxtt9QNOhiEMeZvgqkV_ThyphenhyphenBETkNuworLU3HWfBQlJpvHDl1qwDRaS-YNIYE8MWGN1QL6FEeF6qD8w7JgPLyDH-Rmgv4Ze5Kj4SsXt1DI-r/s1600/2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj32joym13t51GJGppOnvDX-QbvMMeQDkxZpqxtt9QNOhiEMeZvgqkV_ThyphenhyphenBETkNuworLU3HWfBQlJpvHDl1qwDRaS-YNIYE8MWGN1QL6FEeF6qD8w7JgPLyDH-Rmgv4Ze5Kj4SsXt1DI-r/s1600/2.jpg" /></a></div>
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tapi sebelum anda menjalankan UTM Area Measure</div>
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alangkah bainya, Aktifkan GPS terlebih daluhu, untuk menentukan lokasi anda,</div>
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atau posisi tanah yang anda mau ukur</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOzFUvL0gC5hWg4-m398oM7TrXTTNfsf62lbFFqfo-lVKPaUuue4RIhmFxgaeKg-xA7P_VPfDCjNCcrFCnbfeAnh2C4W3XHWYNnoAH-qAzWTtxIhHXpbvzv3Xao7rJ3w1K_ug2u4KXT8qj/s1600/Screenshot_2015-10-05-06-35-37.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOzFUvL0gC5hWg4-m398oM7TrXTTNfsf62lbFFqfo-lVKPaUuue4RIhmFxgaeKg-xA7P_VPfDCjNCcrFCnbfeAnh2C4W3XHWYNnoAH-qAzWTtxIhHXpbvzv3Xao7rJ3w1K_ug2u4KXT8qj/s320/Screenshot_2015-10-05-06-35-37.png" width="192" /></a></div>
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setelah lembar UTM Area Measure terbuka</div>
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maka tampilannya akan seperti ini,</div>
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<br /></div>
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tekan tanda GPS, dan secara langsung lokasi anda akan terbaca</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2JY49lSAnUakE_3jONNzwcsgox58PhIqmZ4gbL13s8MXsNMMeMd8psSKhDJ7HpUupFofZ4K_i-3BL-ZDj9pp1oE4_ylLyIXHG5qEPLBFMMC0Q3JxZSp4HYZIdXCvmZhmirLxM76ltA2Ki/s1600/3.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh2JY49lSAnUakE_3jONNzwcsgox58PhIqmZ4gbL13s8MXsNMMeMd8psSKhDJ7HpUupFofZ4K_i-3BL-ZDj9pp1oE4_ylLyIXHG5qEPLBFMMC0Q3JxZSp4HYZIdXCvmZhmirLxM76ltA2Ki/s320/3.jpg" width="192" /></a></div>
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sentuh menu "tanda 3 titik" maka akan muncul "Choose mode"</div>
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dengan 4 Pilihan</div>
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1. Manual Measuring</div>
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2. GPS Measuring</div>
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3. Open Measuring File</div>
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4. Import ZIP or Text File</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieBlSbgcrvZweLuM9X936d5NFxDU0OIkPD-mA5E-78w_JSrsdBsL9npvKDqFAAG0xyk9YlMRB3ca7k4wsjVrdN1aCddnsnPDM8182tVO9VrGH4GeQ43-c7r5MtNjKRE8qpEuI2BXJrpy-T/s1600/4.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieBlSbgcrvZweLuM9X936d5NFxDU0OIkPD-mA5E-78w_JSrsdBsL9npvKDqFAAG0xyk9YlMRB3ca7k4wsjVrdN1aCddnsnPDM8182tVO9VrGH4GeQ43-c7r5MtNjKRE8qpEuI2BXJrpy-T/s320/4.jpg" width="192" /></a></div>
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Pilih Manual Measuring (karena dengan menu tersebut kita bisa ngukur tanah pekarangan/pertanian dengan cara duduk dan bersantai.</div>
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<br /></div>
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langkah berikutnya pilih "Polygon Measure"</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxdiqXUzC8jpwfbadfNkOyky7xINq9R4EiD8gPNqy2w9Nt-ANKDK3JArbo48WVdI3Im-5fs0Lm1MtCx_5ljC0rrpXSUmVoCv6RWK_AvFGk6d042qLgKZbaobXDVxAV5hgHB5GbdWb_z7FC/s1600/5.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxdiqXUzC8jpwfbadfNkOyky7xINq9R4EiD8gPNqy2w9Nt-ANKDK3JArbo48WVdI3Im-5fs0Lm1MtCx_5ljC0rrpXSUmVoCv6RWK_AvFGk6d042qLgKZbaobXDVxAV5hgHB5GbdWb_z7FC/s320/5.jpg" width="192" /></a></div>
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langkah berikutnya sentuh tiap sudut tanah yang akan diukur,</div>
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perbaiki dengan cara menyentuh tanda titik merah sehingga keluar tanda "+"</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFu8rDCZDNO1Izob_Fh0WewxNs62qldtWqOeiARNnPJOVL6esMODKdjV569wXxsmmc0nRKpv2lMeUJV9W0yz25QcSdHeAFXxhNurOs9P9avWowjvbuA60CV9dAKxzJRuLRu429udjTC7Mq/s1600/6.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFu8rDCZDNO1Izob_Fh0WewxNs62qldtWqOeiARNnPJOVL6esMODKdjV569wXxsmmc0nRKpv2lMeUJV9W0yz25QcSdHeAFXxhNurOs9P9avWowjvbuA60CV9dAKxzJRuLRu429udjTC7Mq/s320/6.jpg" width="192" /></a></div>
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setelah dirasa pas/benar dalam meletakkan titik-titik maka lihat dibagian atas pojok,</div>
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terpampanglah luas ukuran tanah yang kalian ukur..</div>
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sekian tutorial dari saya,</div>
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semoga dapat membantu anda sekalian dalam mengukur tanah secara online..</div>
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NB: tidak dapat dijadikan patokan dalam penentuan ukur yang dilakukan oleh petugas BPN</div>
<br />Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-85351373674372988122015-10-03T22:03:00.002-07:002015-10-03T22:03:29.535-07:00CARA PRINT AKTA DENGAN BROTHER PRINTER MFC-J3720<div class="MsoNormal" style="margin-left: 14.2pt; text-indent: -14.2pt;">
<span lang="EN-US">1. Pastikan Margin
menggunakan Settingan seperti Gambar :<o:p></o:p></span></div>
<br />
<div class="MsoNormal" style="text-indent: 14.2pt;">
<span lang="EN-US"> Page Layout
>> Margins >> Customs Margin<o:p></o:p></span></div>
<div class="MsoNormal" style="text-indent: 14.2pt;">
<span lang="EN-US"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
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<div class="MsoNormal" style="text-indent: 14.2pt;">
<span lang="EN-US"></span></div>
<div class="MsoNormal">
<span lang="EN-US">2. Print Document, Namun Setting Printer
Propertiesnya Setting Seperti di bawah ini :<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US"><br /></span></div>
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<b>SEKIAN TIPS DARI SAYA</b></div>
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<b>SEMOGA BERMANFAAT!!!</b></div>
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Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-87741703342320718132015-10-03T21:39:00.001-07:002015-10-03T21:39:48.987-07:00PERBEDAAN SECARA FISIK SPPT-PBB YANG DIKELUARKAN PRATAMA DAN DISPENDA<div style="text-align: center;">
<b>SPPT-PBB DARI DISPENDA</b></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPz3CO3qaw-ucB20HTIwvkGzVsC7Q5bEr3HKrcgKZueEl2bFlNSi9iKkYPTTVUYFaYUPqhbLuI7QaUdxaSy4AqHzOTV7dM3l8g1VaRWufJ_D8WEONc_vx9hGYu8m7Gu1QJjWbgz02Jvzpi/s1600/sppt+2015.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhPz3CO3qaw-ucB20HTIwvkGzVsC7Q5bEr3HKrcgKZueEl2bFlNSi9iKkYPTTVUYFaYUPqhbLuI7QaUdxaSy4AqHzOTV7dM3l8g1VaRWufJ_D8WEONc_vx9hGYu8m7Gu1QJjWbgz02Jvzpi/s320/sppt+2015.jpg" width="320" /></a></div>
<br />
<br />
<div style="text-align: center;">
<b>SPPT-PBB DARI PRATAMA</b></div>
<div style="text-align: center;">
<b>KANTOR PERPAJAKAN</b></div>
<div style="text-align: center;">
<br /></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR5NDaeDYkgP6I3_fkmV5KEhaiL4fR-pvNK3DCO7tk0ao94JbVD6n1J8R-_IZZ_ZlQuXMSYk2BD1vqPvUp1lXruQZdnxQKq6OAgS9lYX_AEjzmP3V7pSqYi1hWQ9P-CRLzflIQSCR3M6_i/s1600/SPPT+2012.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjR5NDaeDYkgP6I3_fkmV5KEhaiL4fR-pvNK3DCO7tk0ao94JbVD6n1J8R-_IZZ_ZlQuXMSYk2BD1vqPvUp1lXruQZdnxQKq6OAgS9lYX_AEjzmP3V7pSqYi1hWQ9P-CRLzflIQSCR3M6_i/s320/SPPT+2012.jpg" width="320" /></a></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
Dari 2 (dua) buah SPPT-PBB yang berbeda di atas, tampak jelas perbedaanya yaitu dari Latar, Logo, dan Cara Perhitungan Pajak Tahunan.</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
SEMOGA BERMANFAAT!</div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-66959289649805023102015-10-03T05:38:00.000-07:002015-10-03T05:38:49.873-07:00KUASA MENGURUS VALIDASI PAJAK<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b><span lang="EN-GB" style="font-size: 11.0pt;">SURAT KUASA<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-Yang bertanda tangan di bawah ini:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 106.35pt;">
<span lang="EN-GB" style="font-size: 11.0pt;"> N a m a : </span><span style="font-size: 11.0pt; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 106.35pt;">
<span style="font-size: 11.0pt; mso-ansi-language: IN;"> P</span><span lang="EN-GB" style="font-size: 11.0pt;">ekerjaan : </span><span style="font-size: 11.0pt; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 106.35pt; text-indent: -144.0pt;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Alamat</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> </span><span lang="EN-GB" style="font-size: 11.0pt;">: </span><span style="font-size: 11.0pt; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 108.0pt; text-indent: -144.0pt;">
<span lang="EN-GB" style="font-size: 11.0pt;"> N</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">IK :</span><span lang="EN-GB" style="font-size: 11.0pt;"> </span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> </span><span lang="EN-GB" style="font-size: 11.0pt;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-(selanjutnya disebut “Pemberi Kuasa”).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-dengan ini memberi kuasa sepenuhnya dengan
hak subsititusi kepada:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> N a m a : <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Pekerjaan : <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Alamat : <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> NIK : <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-(selajutnya disebut “Penerima Kuasa”).<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"><br /></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<b><span lang="EN-GB" style="font-size: 11.0pt;">----------------------------------------------------
K H U S U S ------------------------------------------------- <o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-bertindak untuk dan atas nama Pemberi
Kuasa selaku P</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">enjual
</span><span lang="EN-GB" style="font-size: 11.0pt;">untuk mengurus validasi pajak
pe</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">njual</span><span lang="EN-GB" style="font-size: 11.0pt;"> di Kantor Pajak atas jual beli tanah</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> & bangunan</span><span lang="EN-GB" style="font-size: 11.0pt;">:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Sertipikat Hak</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> Milik Nomor </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">__</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">/</span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">____</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">, seluas </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">___</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> M2, </span><span lang="EN-GB" style="font-size: 11.0pt;">terletak di</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"> Jalan </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">____________ </span><span style="font-size: 11.0pt; mso-ansi-language: IN;">Nomor </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">___</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">, Kelurahan </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">_____</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">, Kec</span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">amatan _______</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">, Kotamadya</span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">_______________</span><span style="font-size: 11.0pt; mso-ansi-language: IN;">.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;">-Selanjutnya menghadap pejabat Kantor
Pajak, memberi keterangan, membuat dan menandatangani surat, dokumen,
memberikan tanda terima serta melakukan segala tindakan yang dianggap perlu dan
berguna untuk kepentingan Pemberi Kuasa.
</span><span style="font-size: 11.0pt; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Jakarta,</span><span lang="EN-GB" style="font-size: 11.0pt; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">__________<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-size: 11.0pt;"> Pemberi Kuasa Penerima
Kuasa<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<br />
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-US" style="font-size: 11.0pt; mso-ansi-language: EN-US;">_________________ __________________<o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-74354511767620622032015-10-02T05:38:00.001-07:002015-10-03T05:40:33.366-07:00KUASA UNTUK MENJUAL<div class="MsoTitle" style="margin-bottom: 0.0001pt; text-align: center;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">KUASA
UNTUK MENJUAL<o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">
</span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; text-align: center;">
<b><span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">Nomor : [*]<o:p></o:p></span></b></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Pada hari ini, [*], tanggal [*].<o:p></o:p></span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; tab-stops: -36.0pt; text-autospace: ideograph-numeric ideograph-other; text-indent: 0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Pukul
[*] WIB<o:p></o:p></span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; tab-stops: -36.0pt; text-autospace: ideograph-numeric ideograph-other; text-indent: 0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Hadir
di hadapan saya, [*] Sarjana Hukum, Notaris berkedudukan di [*], dengan
dihadiri oleh saksi-saksi yang saya, Notaris, kenal dan yang nama-namanya akan
disebutkan pada bagian akhir akta ini: <o:p></o:p></span></div>
<div class="MsoBodyTextIndent" style="line-height: 150%; margin-left: 0cm; mso-layout-grid-align: auto; mso-pagination: widow-orphan; tab-stops: -36.0pt; text-autospace: ideograph-numeric ideograph-other; text-indent: 0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<i>Tuan <b>[*]</b>,
lahir di [*], pada tanggal [*], Warga Negara [*], [pekerjaan], bertempat
tinggal di [*], Rukun Tetangga [*], Rukun Warga [*], Kelurahan [*], Kecamatan
[*], Kotamadya [*], pemegang Kartu Tanda Pendud</i></span><i><span style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">u</span></i><i><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">k
Nomor Induk Kependudukan [*],</span></i><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;"> yang dalam melakukan perbuatan hukum di bawah
ini telah mendapat persetujuan dan turut
hadir di hadapan saya, Notaris, menandatangani akta ini isterinya, <i>Nyonya <b>[*]</b>,
lahir di [*], pada tanggal [*], Warga Negara [*], [pekerjaan], bertempat
tinggal di [*], Rukun Tetangga [*], Rukun Warga [*], Kelurahan [*], Kecamatan
[*], Kotamadya [*], pemegang Kartu Tanda Pendud</i></span><i><span style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">u</span></i><i><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">k
Nomor Induk Kependudukan [*]</span></i><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Selanjutnya bersama-sama disebut <b>“PEMBERI KUASA”</b>. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: list 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Para penghadap telah saya, Notaris, kenal,
berdasarkan kartu identitas mereka masing-masing.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Pemberi Kuasa tersebut menerangkan dengan ini memberi kuasa
dengan hak untuk mengalihkan kuasa ini kepada orang lain (hak substitusi)
kepada:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<i>Tuan <b>[*]</b>, lahir di [*], pada tanggal [*],
Warga Negara [*], [pekerjaan], bertempat tinggal di [*], Rukun Tetangga [*],
Rukun Warga [*], Kelurahan [*], Kecamatan [*], Kotamadya [*], pemegang Kartu
Tanda Pendud</i></span><i><span style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">u</span></i><i><span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">k
Nomor Induk Kependudukan [*]</span></i><span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">.</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Selanjutnya disebut “<b>PENERIMA
KUASA</b>”.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">----------------------------------- <b>KHUSUS</b> --------------------------------<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-bertindak untuk dan atas nama Pemberi Kuasa untuk menjual, memindahkan hak atau mengalihkan hak
dengan cara apapun atas : </span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: Cambria, serif; font-size: 11pt; line-height: 150%;">-Sebidang
TANAH Sertipikat Hak Milik Nomor [*], seluas [*]M2, Gambar Situasi tanggal [*],
Nomor [*], terletak di [*], Desa [*], Kecamatan [*], Kabupaten [*], Propinsi
[*], tertulis atas nama [*];</span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-(selanjutnya TANAH Sertipikat Hak Milik Nomor [*], termasuk segala sesuatu yang
ditanam, berdiri dan berada di atas TANAH
tersebut dan segala sesuatu yang menurut sifatnya berdasarkan peraturan
perundang-undangan yang berlaku dianggap sebagai benda tetap, baik yang saat
ini ada maupun yang akan ada dikemudian hari, termasuk tanah pecahannya dengan
sertipikat hak atas tanah yang baru disebut “<b>TANAH</b>”), <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<span style="letter-spacing: -.2pt;">kepada pihak manapun
yang ditunjuk oleh Penerima Kuasa dengan
harga dan syarat-syarat serta perjanjian yang dianggap baik dan perlu oleh
Penerima Kuasa untuk kepentingan Pemberi Kuasa dan menurut cara serta yang
sesuai dengan peraturan perundang-undangan yang berlaku dan lazim dalam suatu
jual beli tanah dan bangunan, menerima uang harganya, memberikan kwitansinya,
dan selanjutnya mempertanggung jawabkan hasil penjualannya kepada Pemberi
Kuasa, menandatangani akta jual beli TANAH di hadapan Pejabat Pembuat Akta
Tanah (PPAT) yang berwenang, menyerahkan TANAH yang dijual itu kepada pembeli
yang berhak menerimanya, dan selanjutnya melakukan segala tindakan yang
diperlukan untuk kepentingan Pemberi Kuasa, tanpa ada yang dikecualikan dan
jika masih diperlukan kuasa khusus untuk tindakan tertentu, maka kuasa ini kata
demi kata dianggap telah termasuk dalam kuasa ini.</span></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">--------------------- <b>DEMIKIANLAH
AKTA INI</b> --------------------<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-Dibuat sebagai minuta dan dibacakan serta ditandatangani di
Jakarta, pada hari, tanggal dan jam tersebut di atas dengan dihadiri oleh : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 45.0pt; margin-right: 0cm; margin-top: 0cm; text-indent: -45.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">1. -Nyonya <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 45.0pt; margin-right: 0cm; margin-top: 0cm; text-indent: -45.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">2. -Tuan </span><span style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="FI" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: FI;">-kedua-duanya karyawan Kantor Notaris, sebagai
saksi-saksi. <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="FI" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: FI;">-Segera setelah akta ini dibacakan oleh saya, Notaris,
kepada para penghadap dan saksi-saksi, maka akta ini ditandatangani oleh para
penghadap, saksi-saksi dan saya, Notaris.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="FI" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: FI;">-Dilangsungkan <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<b>DITANDATANGANI OLEH</b>:
--------------------------------------- <o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-
<o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<o:p></o:p></span></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 144.0pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 36.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-hyphenate: none; tab-stops: -36.0pt 108.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;">-<b>DIBERIKAN SEBAGAI SALINAN YANG SAMA
BUNYINYA</b>.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-hyphenate: none; tab-stops: -36.0pt 108.0pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;"> -Notaris<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-hyphenate: none; tab-stops: -36.0pt 108.0pt;">
<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-hyphenate: none; tab-stops: -36.0pt 108.0pt; text-indent: -134.7pt;">
<span lang="EN-GB" style="font-family: "Cambria","serif"; font-size: 11.0pt; line-height: 150%;"> <b>(*) </b></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; mso-hyphenate: none; tab-stops: -36.0pt 108.0pt; text-indent: -134.7pt;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-74127857491345647332015-10-02T00:30:00.001-07:002015-10-03T06:37:35.551-07:00PDO<div style="text-align: center;">
<b><span style="color: blue; font-size: large;"><u>PDO (PURE FISH OIL) ATAU PFO (PURE FISH OIL)</u></span></b></div>
<div style="text-align: center;">
<b><span style="color: blue;"><br /></span></b></div>
<div style="text-align: center;">
<b><span style="color: blue;"><br /></span></b></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><span style="margin-left: auto; margin-right: auto;"><a href="http://birolamongan.blogspot.co.id/2015/10/pdo.html#.Vg_ZaOyqqko"><img border="0" height="289" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOe543j2142emxssb17_G9L2fS6Lr5TdIjszsnhy2xr72qkMw-jeqplPJsWThfBQFdJwB2yHkNOdMgenEwW0zsomQHqu4las5w5q7glG-VuxEe04vBWCDwVGhekEOQu0u5AnK5SwnWBOH6/s320/pdo.jpg" width="320" /></a></span></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><a href="http://birolamongan.blogspot.co.id/2015/10/pdo.html#.Vg_ZaOyqqko">PURE FISH OIL</a></td></tr>
</tbody></table>
<div style="text-align: center;">
<b><span style="color: blue;"><br /></span></b></div>
PDO/PFO adalah Suplemen yang digunakan untuk memelihara kesehatan, mengandung Fish Oil dimana terkandung Asam Lemak Essensial (EFA) yang terdiri dari Omega-6 (LA, GLA), Omega-7 dan Omega-9 (OA)<br />
<br />
PDO/PFO Mengandung OMEGA-3 yang berfungi membantu melancarkan peredaran darah. PDO/PFO juga dipercaya dengan vitamin E.<br />
<br />
OMEGA-3 membantu dalam :<br />
1. Mencegah resiko penyakit jantung, seperti:<br />
- Hiperkolesterolmia (kolesterol tinggi)<br />
- Obesitas (kegemukan)<br />
- Anti agregator (anti pembekuan/penyumbatan pembuluh darah)<br />
2. Meningkatkan Stamina dan daya tahan tubuh<br />
3. Mencegah penyakit degeneratif (penyakit karena faktor usia) seperti :<br />
- Tekanan darah tinggi<br />
- Tekanan darah rendah<br />
- Asam urat<br />
- Diabetes melitus<br />
- Asthma<br />
- Jantung Koroner<br />
- Jantung bengkak/bocor<br />
- Stroke<br />
- Hepatitis<br />
- Parkinson (Tremor)<br />
- Kangker payudara<br />
- Kangker hati (serosis)<br />
- Leukimia<br />
- Kangker rahim<br />
- Kangker paru-paru<br />
4. Mengatasi gangguan menstruasi, menopause, ketidaksuburan dan gangguan prostat<br />
5. Mengoptimalkan fungsi otak, kecerdasan dan penglihatan<br />
6. Mencaga kesehatan kulit dan rambut<br />
7. Menjaga kesehatan sistem saraf<br />
8. Meningkatkan fungsi imunitas<br />
9. Mencegah dan menurunkan resiko kangker<br />
10. Detoksifikasi dan sebagai anti bakteri, dan anti virus<br />
11. Mengontrol tekanan cairan pada mata, telinga dan tulan sendi<br />
12. Mengoptimalkan kesehatan ibu hamil dan menyusui serta menjaga tumbuh<br />
kembang yang sesuai pada bayi dan anak-anak<br />
<br />
<b><u style="background-color: lime;">Komposisi:</u></b><br />
<br />
Fish Oil .......................................... 500 mg<br />
<br />
yang mengandung :<br />
OMEGA - 3 ..................................... 265 mg <br />
OMEGA - 6 ..................................... 70 mg<br />
OMEGA - 7 ..................................... 25 mg<br />
OMEGA - 9 ..................................... 5 mg<br />
Asam Lemak Essensial (EFA) .......... 135 mg<br />
<br />
<u><b><span style="background-color: lime;">Aturan Pakai</span></b>:</u><br />
<br />
Dewasa : 3 x xsehari 1 kapsul<br />
<br />
<b><u style="background-color: lime;">Kemasan :</u></b><br />
<br />
Botol Plastik berisi 30 softgel @ 500 mg<br />
<br />
<div style="text-align: center;">
<b>AMAN DAN BERMANFAAT</b></div>
<div style="text-align: center;">
<b>BAGI IBU HAMIL DAN MENYUSUI</b></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="http://birolamongan.blogspot.co.id/2015/10/pdo.html#.Vg_ZaOyqqko"><img alt=" PDO (PURE DEEP OCEAN)" border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJFg9VV6ZRPgHRKs4hDvD2Kg0bogmBSTpkG-Q5VPpUODqgCqB2l0cL3czwtoz_Y6wmGu72v10aUWPe3neCaWGHqubui9ZbaliClEK4bGjV3B8xEpbJ9abWKEXS9aeJhVDR2RVkmabOc7Ur/s640/pdo+2.jpg" width="200" /></a> </div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://birolamongan.blogspot.co.id/2015/10/pdo.html#.Vg_ZaOyqqko"><img alt=" PDO (PURE DEEP OCEAN)" border="0" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBH-UmE-bmLvgGKTsbFxhufuKVI9ntnrhW72qZ51inBUMbsvXEPgaPT0mofhrvxTRhzilchsPsuKtEsSY3MPE9MnIF_dKiwVGGXlTI2PYwg94mxxHk8FX7qsyYqWUP1po8RXeOJHEC3RHd/s640/pdo+3.jpg" width="196" /></a></div>
<br />
<br />
<div style="text-align: center;">
<b><i><span style="background-color: yellow; font-size: large;">PESAN SEKARANG JUGA!</span></i></b></div>
<div style="text-align: center;">
<b><i style="background-color: yellow;">Dapatkan Potongan Harga Untuk pemesanan Sekarang!</i></b></div>
<div style="text-align: center;">
<span style="text-align: start;">1 BOTOL BERISI 30 KAPSUL @ 500 mg</span></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
<strike><b>Pemesanan 1 Botol (Isi 30) 125.000,-</b></strike></div>
<div style="text-align: center;">
<span style="color: blue; font-size: large;"><b>NOW only Rp. 105.000,-</b></span></div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
<strike><b>Pemesanan 5 Botol (Isi 150) 600.000,-</b></strike></div>
<div style="text-align: center;">
<span style="color: blue; font-size: large;"><b>NOW only Rp. 500.000,-</b></span></div>
<br />
<div style="text-align: center;">
<span style="background-color: yellow;">NB: Harga belum termasuk ongkos kirim</span></div>
<br />
<div style="text-align: center;">
<span style="font-size: large;">SMS : 08563267848</span></div>
<br />
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><b>Cara Pesan:</b></i></span></div>
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><b>NAMA + ALAMAT LENGKAP + PDO/PFO (1 atau 5 Botol)</b></i></span></div>
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><i><br /></i></span></div>
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>Contoh:</i></span></div>
<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif;"><i>Angga + Jln Melati 3, Kec. Jetis, Kab. Lamongan + PDO/PFO 5 Botol</i></span></div>
<br />
<br />
<div style="text-align: center;">
<b>INGAT:</b></div>
<div style="text-align: center;">
<b><br /></b></div>
<div style="text-align: center;">
KESEHATAN NOMOR 1, SO.. HARUS SELALU DIJAGA</div>
<div style="text-align: center;">
DAN MINUM KAPSUL MINYAK IKAN PDO</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: center;">
SEMOGA TUHAN SELALU MEMBERIKAN KEPADA KALIAN SEMUA</div>
<div style="text-align: center;">
AMIN</div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.comtag:blogger.com,1999:blog-8544723909866981672.post-21215180695095442012015-09-25T16:52:00.001-07:002015-10-03T05:41:33.071-07:00SURAT KETERANGAN DOMISILI USAHA (UD, CV, PT)<div class="MsoNormal" style="margin-left: 36.0pt; text-indent: 36.0pt;">
<b><span lang="EN-US" style="font-size: 14.0pt;"> <o:p></o:p></span></b></div>
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<tbody>
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<tbody>
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</tr>
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<td></td>
<td></td>
</tr>
</tbody></table>
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margin-left:17.6pt;margin-top:0;width:60.55pt;height:64.4pt;z-index:251657216;
visibility:visible;mso-wrap-edited:f' filled="t" fillcolor="black">
<v:imagedata src="file:///C:\Users\ACER\AppData\Local\Temp\msohtmlclip1\01\clip_image001.png"
o:title=""/>
<w:wrap type="topAndBottom"/>
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ShapeID="_x0000_s1026" DrawAspect="Content" ObjectID="_1504755393">
</o:OLEObject>
<![endif]><![endif]--><!--[if !vml]-->
<!--[endif]--><!--[if gte vml 1]></o:wrapblock><![endif]--><br />
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z-index:251658240' from="0,84.6pt" to="434.15pt,84.6pt" strokeweight="4.5pt">
<v:stroke linestyle="thinThick"/>
</v:line><![endif]--><!--[if !vml]--><span style="height: 7px; margin-left: -3px; margin-top: 109px; mso-ignore: vglayout; position: absolute; width: 585px; z-index: 251658240;"></span><!--[endif]--><span lang="EN-US"><o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 333.35pt;" valign="top" width="444"><div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: -.9pt; margin-right: -5.4pt; margin-top: 0cm;">
<b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">PEMERINTAH
KABUPATEN LAMONGAN</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></b></div>
<div class="MsoHeader" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: -.9pt; margin-right: 62.1pt; margin-top: 0cm;">
<b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">KECAMATAN</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN;"> : ...............................<o:p></o:p></span></b></div>
<div class="MsoNormal" style="line-height: 150%; margin-right: 66.6pt; tab-stops: 318.6pt;">
<div class="separator" style="clear: both; text-align: center;">
</div>
<b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;">DESA/KELURAHAN</span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%; mso-ansi-language: IN;"> : ...............................</span></b><span lang="EN-US" style="font-family: "Arial","sans-serif"; font-size: 14.0pt; line-height: 150%;"><o:p></o:p></span></div>
</td>
</tr>
<tr>
<td style="border: none; mso-border-top-alt: solid windowtext .5pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 104.4pt;" valign="top" width="139"><div class="MsoNormal">
<br /></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 333.35pt;" valign="top" width="444"><div class="MsoHeader" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: -.9pt; margin-right: 62.1pt; margin-top: 0cm;">
<br /></div>
</td>
</tr>
</tbody></table>
<div class="MsoNormal">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<st1:city w:st="on"><st1:place w:st="on"><b><u><span lang="EN-US" style="font-size: 16.0pt;">SURAT</span></u></b></st1:place></st1:city><b><u><span lang="EN-US" style="font-size: 16.0pt;">
KETERANGAN DOMISILI USAHA</span></u></b><b><u><span lang="EN-US" style="font-size: 16.0pt;"> <o:p></o:p></span></u></b></div>
<div class="MsoNormal">
<b> <span lang="EN-US">NOMOR </span></b><b>:<span lang="EN-US"> </span></b><b> <span lang="EN-US"> </span></b><b><span lang="EN-US"> </span><span lang="EN-US"> </span></b><b><o:p></o:p></b></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-indent: 36.0pt;">
<span lang="EN-US">Yang bertanda tangan dibawah ini kami Kepala</span><span lang="EN-US"> </span>Desa/Kelurahan
..........................
..............................................................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">Menerangan dengan
sesungguhnya bahwa :</span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-align: justify;">
<span lang="EN-US">1. Nama :</span><span lang="EN-US"> </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%; margin-left: 148.85pt; text-indent: -148.85pt;">
<span lang="EN-US">2. Alamat </span><span lang="EN-US"> </span> <span lang="EN-US">: </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">3. Pekerjaan : </span><o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
4. Tempat / Tanggal Lahir :<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">Orang tersebut
diatas benar</span>-<span lang="EN-US">benar
mempunyai kegiatan usaha berbentuk </span>Koperasi
/ PT / Fa / CV / UD / TOKO :
......................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
Dengan Dagangan Utama :
................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
............................................................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
............................................................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">yang berlokasi </span>di
................................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
............................................................................................................................................<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<span lang="EN-US">Sedang tempat
usaha berupa tanah dan gedung yang dipakai
untuk melakukan kegiatan usaha adalah milik</span> sendiri / orang lain (menyewa) dengan bukti
terlampir.<o:p></o:p></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 115%; text-indent: 36.0pt;">
<span lang="EN-US">Demikian <st1:city w:st="on"><st1:place w:st="on">surat</st1:place></st1:city>
keterangan ini kami buat dengan sebenarnya.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 115%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 284.25pt;">
<span lang="EN-US">
</span> <o:p></o:p></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 284.25pt;">
<br /></div>
<div class="MsoNormal">
<b><span lang="EN-US"> </span></b><b>YANG BERSANGKUTAN KEPALA DESA/KELURAHAN
<o:p></o:p></b></div>
<div class="MsoNormal">
<b> <o:p></o:p></b></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b>
.................................................... .......................................................</b><span lang="EN-US"><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<br /></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-2517664679056849652015-09-25T16:48:00.000-07:002015-10-03T18:22:03.982-07:00BERITA ACARA KESAKSIAN RIWAYAT TANAH<div align="center" class="MsoNoSpacing" style="line-height: 115%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">BERITA ACARA KESAKSIAN<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-indent: 18.0pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pada hari
ini, ……………………….. tanggal ……………. Kami yang bertanda tangan dibawah ini :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: 155.95pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama : ………………………………………………………..</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">U</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">mur :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................. Tahun <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat : ………………………………………………………..</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : ………………………………………………………..</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; mso-list: l2 level1 lfo1; tab-stops: 155.95pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Umur : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................. Tahun<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : ………………………………………………………..</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat :</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">………………………………………………………..</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan ini
memberikan kesaksian atas pemilikan/ penguasaan sebidang tanah yang terletak di
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">De</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">sa ……</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">............................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">… kecamatan
…</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">….. kabupaten Lamongan. Sebagaimana tersebut pada
Petok D/ C Desa Nomor …</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.............
</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Persil …</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">..............</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kelas Desa …</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">….. Luas ……</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.............</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">….. M2. Tertulis atas nama </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">............................................................................................................... </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan
batas-batas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Utara : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Timur : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Selatan : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Barat : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 155.95pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bahwa </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">riwayat tanah tersebut </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">s</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">ebelum tahun 1960</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">, tercatat
pada Girik/Petok D/Letter C Desa/Pajak Nomor …</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........,
Persil ............, Klas ............, Luas ....................... M2, atas
nama ...............................................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pada tahun
1960 dikuasai oleh ..........................................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l0 level1 lfo3; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pada tanggal
..............................................................., seluas <u>+</u>
.................... M2, dialihkan kepada ................................................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-align: justify;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Sampai saat
ini dikuasai oleh</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">............................................................................................ </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Adalah orang yang sebenarnya berhak atas tanah
dimaksud.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian berita
acara ini dibuat untuk dipergunakan sebagaimana mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang membuat
kesaksian<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt 5.0cm center 361.5pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">......................................... </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">( )<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; tab-stops: 21.3pt 5.0cm center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt 5.0cm center 361.5pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.........................................</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">( )<o:p></o:p></span></div>
<div class="MsoListParagraph">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <b><u>MENGETAHUI :<o:p></o:p></u></b></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kepala
Desa/ Lurah </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...............................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 21.3pt center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><b><u><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">..............................................</span></u></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com2tag:blogger.com,1999:blog-8544723909866981672.post-91507559344709400942015-09-25T16:46:00.002-07:002015-10-03T05:47:34.616-07:00SURAT PERNYATAAN HIBAH<div align="center" class="MsoNoSpacing" style="line-height: 115%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">SURAT PERNYATAAN HIBAH<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang
bertanda tangan dibawah ini :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: 155.95pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tempat/
Tgl lahir :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bertindak
untuk dan atas nama para ahli waris ……………………………………….. berdasarkan Surat Kuasa
tanggal ……………………………………………………………....<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Untuk
selanjutnya disebut sebagai <b>Pihak
Pertama.</b><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: 155.95pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tempat/
Tgl lahir :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt; tab-stops: 155.95pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat : ………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 36.0pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Untuk
selanjutnya disebut sebagai <b>Pihak Kedua.<o:p></o:p></b></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pihak
Pertama menerangakan dengan ini mengibahkan sebidang tanah bekas yasan/bekas
gogolan kepada Pihak Kedua dan Pihak Kedua menerangkan dengan ini menerima
sebidang tanah bekas yasan/ bekas gogolan dari pihak Pertama atas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">sebidang
tanah pekarangan/ Pertanian yang tercatat pada C. Desa Nomor : ……………………..
persil ……..…. Kelas Desa ……..…… Luas …………… m2/ sebagian dari ………….... M2,
terletak di Desa ……………………..….…… kecamatan ………………….…. Kab. Lamongan, dengan
batas-batas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 2.0cm 155.95pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Utara :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 2.0cm 155.95pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Timur :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 2.0cm 155.95pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Selattan :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 2.0cm; tab-stops: 2.0cm 155.95pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Barat :
………………………………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">pihak Perama
dan Pihak Kedua menerangkan bahwa Hibah ini dilakukan tanpa paksaan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Transaksi
Hibah sebidang tanah bekas yasan/ bekas gogolan ini dilakukan pada tanggal
……………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pihak
pertama menjamin bahwa obyek HIbah sebidang tanah bekas yasan/ bekas gogolan
tersebut diatas tidak tersangkut dalam suatu sengketa, bebas dari sitaan, tidak
terkait sebagai jaminan atau hutang.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Transaksi
Hibah sebidang tanah bekas yasan/ bekas gogolan ini juga dihadiri para saksi
seperti tersebut dibawah ini :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l1 level1 lfo2; tab-stops: 21.3pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian
Surat Pernyataan Hibah ini kami buat dalam keadaan sehat wal’afiat tanpa ada
paksaan dari pihak lain untuk dipergunakan sebagai mana mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; tab-stops: 21.3pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Lamongan,
Tgl ………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Yang
menyatakan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Pihak
kedua<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <b><u>…………………………………..<o:p></o:p></u></b></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Saksi-saksi<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l2 level1 lfo3; tab-stops: center 361.5pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">…………………………….. ( ) <b>MENGETAHUI :</b><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kepala
Desa/ Lurah ………….<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">…………………………….. ( )<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 361.5pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <b><u>…………………………………..</u></b><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-34937356874229926372015-09-25T16:44:00.003-07:002015-10-03T05:48:03.849-07:00SURAT PERNYATAAN KUTIPAN PENGESAHAN GOGOL HILANG<div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">SURAT PERNYATAAN KUTIPAN PENGESAHAN GOGOLAN
HILANG<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang
bertanda tangan dibawah ini, saya :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo3; tab-stops: 4.0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo3; tab-stops: 4.0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Umur : …………… tahun<o:p></o:p></span></div>
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<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo3; tab-stops: 4.0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo3; tab-stops: 4.0cm; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Identitas : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 4.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan ini
menyatakan dengan sebenarnya bahwa KUTIPAN Surat Keputusan Kepala Inspeksi Agraria
Jawa Timur tanggal ……………………….... Nomor : I/AGR/ … / HM/III/1964 <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">(Penegasan
Tanah Bekas Gogolan tetap menjadi Hak Milik ):<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l1 level1 lfo1; tab-stops: 4.0cm; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">a.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Atas nama :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l1 level1 lfo1; tab-stops: 4.0cm; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">b.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">No. Petok/ Pipil :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l1 level1 lfo1; tab-stops: 4.0cm; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">c.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nomor Persil : ……………., Kelas …………, Luas ………… M2<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; tab-stops: 4.0cm; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Nomor Persil : …………....., Kelas ……....…, Luas ….………
M2<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; tab-stops: 4.0cm; text-align: justify;">
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2</div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Terletak di
Desa/ Kelurahan...........… Kecamatan ………….…..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Kabupaten
Lamongan, telah <b>HILANG</b>:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 70.9pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pada : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 70.9pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Di :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 70.9pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Akibat : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian
untuk menjadikan periksa dan pernyataan ini saya buat sebagai lampiran
permohonan Pengajuan Sertipikat Redistribusi.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Lamongan,
tgl ………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> MENGETAHUI DAN MEMBENARKAN Yang menyatakan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> KEPALA DESA/ KEL ……………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 4.0cm 12.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <u>………………………..</u><b> </b><u>………………………..<b><o:p></o:p></b></u></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 12.0cm; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Lamongan,
tgl ………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="tab-stops: 262.25pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kepada<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="tab-stops: 262.25pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Yth.
Bapak. Kepala kantor Pertanahan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="tab-stops: 326.05pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kabupaten
lamongan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="tab-stops: 326.05pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Di<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="tab-stops: 12.0cm; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <b><u>LAMONGAN<o:p></o:p></u></b></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan
hormat,<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang
bertanda tangan dibawah ini :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 106.35pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 106.35pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Umur :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 106.35pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pekerjaan : …………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 106.35pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Alamat :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bertindak
sebagai : Pemegang Hak/ Pembeli/ Penerima Hibah/ Ahli Waris/ Kuasa *)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan
riwayat perolehan sebagai berikut :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Pewaris
meninggal dunia pada tahun ……… Di Desa/ Kel. ……………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Jual Beli/ Hibah
tanggal : ………… ( Akta : No. ………………………………. )<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bersama ini
saya mohon untuk diterbitkan salinan data Surat Keputusan Kepala Inspeksi
Agraria Jawa Timur tanggal ………………. Nomor : I/AGR/ … / HM/ III/1964<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">(Penegasan
tanah bekas gogolan tetap untuk dikonversi menjadi hak milik) sebagaimana tercantum
sebagai beriktu :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama pemegang SK :
…………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nomor pada Pipil/ petok/ Buku C. Desa : ……………………………………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l2 level1 lfo2; tab-stops: 4.0cm; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span>Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2</div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; tab-stops: 4.0cm; text-align: justify;">
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2<br />
Nomor Persil : …………....., Kelas ……....…, Luas ….……… M2</div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Terletak di desa : …………………., Kecamatan : …………………. Kab.
Lamongan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; mso-list: l2 level1 lfo2; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">5.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Permohonan ini saya maksudkan untuk pengurusan sertipikat, karena KUTIPAN ASLI sampai saat ini hilang/ rusak dan bidang tanah yang dimohon telah
saya kuasai secara fisik serta tidak dalam keadaan sengketa dan belum pernah
didaftarkan sertipikat.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian
untuk menjadi periksa dan atas terkabulnya permohonan ini, kami sampaikan
terima kasih.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 21.3pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 120.5pt 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> MENGETAHUI DAN MEMBENARKAN Yang menyatakan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 120.5pt 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> KEPALA DESA/ KEL ……………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 120.5pt 354.4pt;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 120.5pt 354.4pt;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 120.5pt 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <u>…………………………..</u> <u>………………………..</u><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-92127960007992408552015-09-25T16:38:00.001-07:002015-10-03T05:48:51.942-07:00SURAT PERNYATAAN PELEPASAN UNTUK AKSES JALAN ATAU KEPENTINGAN UMUM<div align="center" class="MsoNormal" style="text-align: center;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><st1:city w:st="on"><st1:place w:st="on"><b><u><span lang="EN-US" style="font-size: 14.0pt;">SURAT</span></u></b></st1:place></st1:city><b><u><span lang="EN-US" style="font-size: 14.0pt;">
PERNYATAAN <o:p></o:p></span></u></b></div>
<div class="MsoNormal">
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<br /></div>
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<div class="MsoNormal" style="line-height: 150%; text-indent: 36.0pt;">
<span lang="EN-US">Yang bertanda tangan dibawah ini :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">N a m a :
……………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">U m u r :
……………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Pekerjaan : ……………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Alamat : ……………. ………………………………………………..<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 50%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US">Menyatakan dengan benar bahwa<b>
</b>:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US">Saya
adalah pemilik tanah tersebut dalam Sertipikat Hak Milik Nomor :…………………………...<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US">Tanah
tersebut saat ini saya jual sebagian ( kapling ).<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US">Karena
belum ada fasilitas umum, maka saya beri dan saya lepaskan untuk jalan, lebih
kurang ……….M2, yaitu lebar …………meter,
sepanjang ………..meter.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; mso-list: l0 level1 lfo1; tab-stops: list 36.0pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US">Karena
sudah saya lepaskan, maka saya tidak akan meminta kembali fasilitas umum
tersebut. <o:p></o:p></span></div>
<div class="MsoNormal" style="text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US">Demikian Surat Pernyataan Pelepasan Fasilitas Umum ini
saya buat dengan benar dan sanggup dituntut sesuai dengan hukum yang berlaku
apabila saya mengingkarinya.<o:p></o:p></span></div>
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<br /></div>
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<br /></div>
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<table border="0" cellpadding="0" cellspacing="0" class="MsoTableGrid" style="border-collapse: collapse; border: none; mso-border-insideh: none; mso-border-insidev: none; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr style="height: 129.0pt; mso-yfti-firstrow: yes; mso-yfti-irow: 0; mso-yfti-lastrow: yes;">
<td style="height: 129.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 257.4pt;" valign="top" width="343"><div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span lang="EN-US">Mengetahui
:<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US"> KEPALA DESA .........................<o:p></o:p></span></div>
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<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
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<br /></div>
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<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span lang="EN-US">______________________<o:p></o:p></span></div>
</td>
<td style="height: 129.0pt; padding: 0cm 5.4pt 0cm 5.4pt; width: 264.6pt;" valign="top" width="353"><div class="MsoNormal" style="margin-left: 21.6pt;">
<span lang="EN-US">……………..., Tgl.
………………….<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span lang="EN-US">YANG
MEMBUAT PERNYATAAN<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><span lang="EN-US" style="font-size: 8.0pt;">Materai
<o:p></o:p></span></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<i><span lang="EN-US" style="font-size: 8.0pt;">Rp.
6.000,-<o:p></o:p></span></i></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<span lang="EN-US">_____________________<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="text-align: center;">
<br /></div>
</td>
</tr>
</tbody></table>
<br />
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-3889352477216380652015-09-25T16:33:00.001-07:002015-10-03T05:49:32.029-07:00SURAT PERNYATAAN HARTA ASAL (BUKAN HARTA GONO GINI)<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<st1:city w:st="on"><st1:place w:st="on"><b><u><span lang="EN-US">SURAT</span></u></b></st1:place></st1:city><b><u><span lang="EN-US"> PERNYATAAN<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-indent: 36.0pt;">
<span lang="EN-US">Yang bertanda tangan dibawah ini :<o:p></o:p></span></div>
<table border="0" cellpadding="0" cellspacing="0" class="MsoNormalTable" style="border-collapse: collapse; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt; mso-yfti-tbllook: 480;">
<tbody>
<tr>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 77.4pt;" valign="top" width="103"><div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Nama<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Umur<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Pekerjaan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<span lang="EN-US">Alamat<o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 18.0pt;" valign="top" width="24"><div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-US">:<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-US">:<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-US">:<o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<span lang="EN-US">:<o:p></o:p></span></div>
</td>
<td style="padding: 0cm 5.4pt 0cm 5.4pt; width: 347.4pt;" valign="top" width="463"><div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><span lang="EN-US">Desa ........, Kecamatan ......., Kabupaten Lamongan</span></div>
</td></tr>
</tbody></table>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US">Dengan ini menyatakan dengan sebenarnya bahwa tanah yang saya miliki
berdasarkan Surat Keputusan Kepala Inspeksi Agraria Jawa Timur tanggal <st1:date day="29" month="12" w:st="on" year="1964">29-12-1964</st1:date> Nomor : I/AGR/89/HM/III/1964
terletak di Desa Sumberaji, Kecamatan Sukodadi, Kabupaten Lamongan, yang memuat
: <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US">- Persil Kelas Desa
Luas
: M<sup>2</sup><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US">- Persil Kelas
Desa Luas
: M<sup>2</sup><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<b><u><span lang="EN-US">Adalah benar – benar
merupakan harta asal yang kami peroleh sebelum menikah dan bukan merupakan harta gono – gini .<o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US">Demikian <st1:city w:st="on"><st1:place w:st="on">surat</st1:place></st1:city>
pernyataan ini saya buat dengan sebenarnya dan apabila dikemudian hari ternyata
pernyataan ini tidak benar maka saya sanggup dituntut sesuai ketentuan yang
berlaku.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
Yang Menyatakan,<o:p></o:p></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<br /></div>
<br />
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
....................................<o:p></o:p></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-16432852761057105292015-09-25T16:30:00.001-07:002015-10-03T05:49:58.615-07:00SURAT PENCABUTAN BERKAS DI BPN<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Lamongan,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kepada<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Yth.Kepala
Kantor Pertanahan<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kabupaten
Lamongan<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Di<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> <u>LAMONGAN<o:p></o:p></u></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Dengan hormat,<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Yang bertanda tangan di bawah ini
Saya :<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Nama : ...........................<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Umur : ...........................<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Pekerjaan : ...........................<o:p></o:p></span></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Alamat : ...........................<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Mengajukan
pencabutan berkas atas nama</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">……………</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">tgl.</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">pendaftaran
………………<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Nomor Berkas </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">:<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">D I. 305 :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">D I. 301 :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">D I. 302 :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="mso-list: l0 level1 lfo1; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US">-<span style="font-size: 7pt; font-stretch: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";">D I. 303 :<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpLast">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Alasan pencabutan karena
…………………………………………………………<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Demikian surat pncabutan kami buat dan
harap maklum.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">
Hormat kami</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">,<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">
.........................<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> <o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-26414183416457111122015-09-25T16:24:00.002-07:002015-10-03T05:50:35.266-07:00SURAT KETERANGAN LUNAS PAJAK KEPALA DESA<div align="center" class="MsoNoSpacing" style="text-align: center;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">PEMERINTAH
KABUPATEN LAMONGAN<o:p></o:p></span></b></div>
<div align="left" class="MsoNoSpacing" style="margin-left: 4cm;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">KECAMATAN : </span></b><b><span style="font-family: "Cambria","serif"; font-size: 14.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">..................................<o:p></o:p></span></b></div>
<div align="left" class="MsoNoSpacing" style="margin-left: 4cm;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">DESA
/ <s>KELURAHAN</s> : </span></b><b><span style="font-family: "Cambria","serif"; font-size: 14.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">..................................<o:p></o:p></span></b></div>
<div align="left" class="MsoNoSpacing" style="margin-left: 106.35pt;">
<br /></div>
<div class="MsoNoSpacing">
<v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t32" o:oned="t" o:spt="32" path="m,l21600,21600e">
<v:path arrowok="t" fillok="f" o:connecttype="none">
<o:lock shapetype="t" v:ext="edit">
</o:lock></v:path></v:shapetype><v:shape id="_x0000_s1026" o:connectortype="straight" style="height: 0px; left: 0px; margin-left: 0px; margin-top: 2.6pt; position: absolute; width: 468pt; z-index: 251658240;" type="#_x0000_t32"><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> </span></v:shape></div>
<br clear="ALL" />
<br />
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">SURAT
KETERANGAN<o:p></o:p></span></u></b></div>
<div align="left" class="MsoNoSpacing">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> No
:<o:p></o:p></span></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> Yang bertanda
tangan di bawah ini Kepala Desa/<s>Lurah</s> ………………………………, Kecamatan …………………………,
Kabupaten Lamongan dengan ini dmenerangkan bahwa Pajak Bumi dan Bangunan atas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">Nama Wajib Pajak : ………………………………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">Alamat :
………………………………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">NO. SPPT (NOP) : ………………………………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">Letak objek Pajak : ………………………………………<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">Telah </span><b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 13.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">dibayar
lunas</span></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">Demikian Surat Keterangan ini kami buat dengan benar untuk
dipergunakan sebagaimana mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;">
<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> Kepala
Desa<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> ……………………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: "Courier New"; mso-hansi-theme-font: major-latin;"> <b>(…………………………..)<o:p></o:p></b></span></div>
<br />
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 354.4pt;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-74709339149544915702015-09-25T16:19:00.001-07:002015-10-03T05:51:00.553-07:00SURAT KETERANGAN BEDA NAMA ANTARA BUKU C.DESA DAN GOGOL (SK. KINAG)<div align="center" class="MsoNoSpacing" style="text-align: center;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">PEMERINTAH KABUPATEN DAERAH
TINGKAT II LAMONGAN<o:p></o:p></span></b></div>
<div align="left" class="MsoNoSpacing" style="margin-left: 127.6pt;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">KECAMATAN : </span></b><b><i><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................</span></i></b><b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></b></div>
<div align="left" class="MsoNoSpacing" style="margin-left: 127.6pt;">
<b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">DESA/KELURAHAN : </span></b><b><i><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................</span></i></b><b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></b></div>
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<br /></div>
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t32" o:oned="t" o:spt="32" path="m,l21600,21600e">
<v:path arrowok="t" fillok="f" o:connecttype="none">
<o:lock shapetype="t" v:ext="edit">
</o:lock></v:path></v:shapetype><v:shape id="_x0000_s1026" o:connectortype="straight" strokeweight="2.25pt" style="height: 0; left: 0; margin-left: 0; margin-top: 1.5pt; position: absolute; text-align: left; width: 465.75pt; z-index: 251658240;" type="#_x0000_t32"><b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span></u></b></v:shape></div>
<br clear="ALL" />
<br />
<div align="center" class="MsoNoSpacing" style="text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">SURAT PERNYATAAN<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang
bertanda tangan dibawah ini, Kepala Desa/Lurah </span><b><i><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.................</span></i></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kecamatan </span><b><i><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.....................</span></i></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">. Kabupaten Daerah Tingkat II Lamongan,
menerangkan bahwa :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tanah
pertanian bekas gogolan berdasarkan Buku C. Desa Nomor Tercatat atas nama yang memuat :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; tab-stops: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; tab-stops: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm; tab-stops: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Berdasarkan
Rembuk Desa </span><b><i><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.....................</span></i></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tanggal</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">..............................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang disahkan oleh Kepala Daerah
Kabupaten Lamongan tanggal </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">nomor Pst/</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">..............</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> /B/1963 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dan sesuai
dengan keputusan Kepala Inspeksi Agraria Jawa Timur tanggal Nomor : I/AGR/ /HM/III/1964 tanah pertanian bekas gogolan
tersebut di konversi menjadi hak milik atas nama </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">............................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">yang memuat
:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil :
………. Kelas Desa : ……………… Luas : ……………. M2 ;<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dasar/alas
hak yang dipakai dalam pembuatan akta berpedoman pada SK gogolan <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">(SK Kinag
Jatim Nomor : I/AGR/ /HM/III/1964 tersebut di atas.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian
Surat Keterangan ini kami buat dengan benar dan sesungguhnya mengingat sumpah
jabatan untuk dipergunakan sebagaimana mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 1.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 10.0cm;">
<a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><a href="https://www.blogger.com/blogger.g?blogID=8544723909866981672" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"></a><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> ..................,
Tgl ...........</span> Kepala
Desa/Lurah .............</div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 10.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 10.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 10.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: 10.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt;">(</span><span style="font-family: Cambria, serif; font-size: 12pt;">..........................................</span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt;">)</span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-87372053335573099832015-09-25T16:10:00.002-07:002015-10-03T18:21:35.219-07:00PASAL 39 (SURAT PERNYATAAN BELUM PERNAH DIAJUKAN PENDAFTARAN SERTIPIKAT)<div align="right" class="MsoNoSpacing" style="line-height: 150%; text-align: right;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 10.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Psl. : 39
(b.2) PP.24/97<o:p></o:p></span></div>
<div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 16.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">SURAT PERNYATAAN<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang bertanda
tangan dibawah ini :<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Nama :
</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Umur </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">: .......</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> tahun <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Warga Negara : Indonesia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Pekerjaan
:</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">
...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Tempat Tinggal <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Desa/Kelurahan :</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> ...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kecamatan
:</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">
...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kabupaten
: </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-top: 12.0pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan ini
menyatakan :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Petok D/C
desa Nomor : </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">............ </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> (SK Penegasan Gogol Nomor :
I/AGR/……../HM/III/1964). *)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Persil nomor
:</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> .........</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Klas Desa :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> ............ </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Luas </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> ................. </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> m2<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tertulis
atas nama : </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...............................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Terletak di
Desa/Kelurahan *) </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">..................................... </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kecamatan : </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Kabupaten
Lamongan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan
batas-batas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 1.0cm; tab-stops: 106.35pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Utara : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 1.0cm; tab-stops: 106.35pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Timur : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 1.0cm; tab-stops: 106.35pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Selatan : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 1.0cm; tab-stops: 106.35pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Barat : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bahwa tanah
tersebut diatas </span><b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 13.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">belum pernah</span></u></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> diajukan
pendaftaran Sertipikat.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Demikian
surat pernyataan ini kami buat dengan sesungguhnya untuk dipergunakan
sebagaimana mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................... </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tgl
……………………………..<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kami
yang menyatakan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...................................</span><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></u></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <u>MENGETAHUI
:<o:p></o:p></u></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> KEPALA
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">DESA ...................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 9.0cm;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 150%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> <u>………………………………………………….</u><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-23390031176981105402015-09-25T16:08:00.001-07:002015-10-03T18:20:27.532-07:00PASAL 76 (PENGUASAAN FISIK BIDANG TANAH)<div align="right" class="MsoNoSpacing" style="line-height: 142%; text-align: right;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 10.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Lampiran ’14
(Pas. 76 (3) PMNA / KBPN 3/97)<o:p></o:p></span></div>
<div align="right" class="MsoNoSpacing" style="line-height: 142%; text-align: right;">
<br /></div>
<div align="center" class="MsoNoSpacing" style="line-height: 142%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 14.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">SURAT PERNYATAAN PENGUASAAN FISIK BIDANG TANAH<o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 142%;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang
bertanda tangan dibawah ini:<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Nama
: </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Umur </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">: .......</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> tahun <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Warga Negara : Indonesia<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Pekerjaan
:</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">
...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> Tempat Tinggal <o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Desa/Kelurahan :</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"> ...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kecamatan
:</span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">
...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6pt; text-align: justify; text-indent: 36pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif";">Kabupaten
: </span><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Dengan ini
menyatakan bahwa saya dengan itikad baik telah mengasai sebidang tanah yang
terletak di :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Jalan : ………………………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Desa/Kelurarahan :</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="color: white; font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-themecolor: background1;">Kemantren</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kecamatan : </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="color: white; font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin; mso-themecolor: background1;">Paciran</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Kabupaten : <b>LAMONGAN</b><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> NIB : ………………………………………………………………………………….<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Status Tanah : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> Dipergunakan :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;">Batas-batas tanah<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> Utara : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> Timur : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> Selatan : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> Barat : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">...........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 14.2pt; mso-list: l2 level1 lfo1; tab-stops: 42.55pt 148.85pt; text-indent: -10.9pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;">Bidang tanah tersebut saya perolah karena</span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> </span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;"> </span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;">..........................</span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;">sejak tahun </span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 115%;">..............</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 14.2pt; mso-list: l2 level1 lfo1; tab-stops: 42.55pt 148.85pt; text-indent: -10.9pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: Cambria; mso-fareast-font-family: Cambria;">-<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Bidang tanah
tersebut dimiliki oleh orang tua sejak tahun</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">
.......................... </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">*)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 42.55pt 148.85pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Yang sampai saat ini saya kuasai secara terus menerus, tidak
dijadikan jaminan sesuatu hutang dan tidak dalam keadaan sengketa. Surat
Pernyataan ini saya buat dengan sebenarnya dengan penuh tanggung jawab dan saya
bersedia untuk mengangkat sumpah apabila diperlukan. Apabila pernyataan ini
tidak benar saya bersedia dituntut dihadapan pihak-pihak yang berwenang.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 14.2pt 148.85pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Demikian Surat Pernyataan ini kami buat
dihadapan saksi-saksi :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-left: 35.45pt; mso-list: l0 level1 lfo2; tab-stops: 14.2pt 35.45pt 99.25pt 10.0cm 304.8pt 361.5pt; text-indent: -21.25pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-bidi-font-family: Cambria; mso-bidi-theme-font: major-latin; mso-fareast-font-family: Cambria; mso-fareast-theme-font: major-latin; mso-hansi-theme-font: major-latin;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Nama : </span><b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">................................</span></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> 2. Nama :
</span><b><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">....................................</span></b><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-left: 35.45pt; tab-stops: 14.2pt 21.3pt 35.45pt 42.55pt 99.25pt 10.0cm 304.8pt 361.5pt; text-indent: -21.25pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Umur :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">........... Tahun</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Umur : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">......... Tahun</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-left: 35.45pt; tab-stops: 14.2pt 35.45pt 42.55pt 99.25pt 10.0cm 304.8pt 361.5pt; text-indent: -21.25pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Pekerjaan :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">....................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Pekerjaan : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-left: 35.45pt; tab-stops: 14.2pt 35.45pt 42.55pt 99.25pt 10.0cm 304.8pt 361.5pt; text-indent: -21.25pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Alamat :
</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">....................................</span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Alamat : </span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.........................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 375.65pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> </span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">............................</span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">, </span><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Tgl.</span><span style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ansi-language: IN; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">.....................................<o:p></o:p></span></div>
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<!--[endif]--></v:textbox>
</v:stroke></v:rect><span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> Yang
menyatakan<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 375.65pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;">Saksi-saksi</span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-bottom: 12.0pt; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-list: l1 level1 lfo3; tab-stops: 134.7pt center 375.65pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">..................................... </span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">( )<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; margin-left: 21.3pt; mso-list: l1 level1 lfo3; tab-stops: 134.7pt center 375.65pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">..................................... </span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">( ) </span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">(......................................)</span><span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;"> </span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;"> MENGETAHUI
:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<span lang="EN-US" style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;"> KEPALA
DES</span><span style="font-family: Cambria, serif; font-size: 12pt; line-height: 142%;">A
....................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 142%; tab-stops: center 241.0pt;">
<span lang="EN-US" style="font-family: "Cambria","serif"; font-size: 12.0pt; line-height: 142%; mso-ascii-theme-font: major-latin; mso-hansi-theme-font: major-latin;"> …………………………………………………..<o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-86890389999241923372015-09-24T18:16:00.003-07:002015-10-03T18:23:01.343-07:00FORM PASAL 99 (ASPEK PERTANIAN)<div align="right" class="MsoNormal" style="line-height: 150%; text-align: right;">
<u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 10.0pt; line-height: 150%;">Psl.
99 PMNA/KBPN 3/97<o:p></o:p></span></u></div>
<div align="center" class="MsoNormal" style="line-height: 150%; text-align: center;">
<st1:place w:st="on"><st1:city w:st="on"><b><u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 13.0pt; line-height: 150%;">SURAT</span></u></b></st1:city></st1:place><b><u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 13.0pt; line-height: 150%;">
PERNYATAAN <o:p></o:p></span></u></b></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Yang bertanda tangan di bawah ini,
kami : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Nama : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
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<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Umur </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">: .......</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">
tahun <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Warga Negara : Indonesia<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Pekerjaan :</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Tempat Tinggal <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Desa/Kelurahan :</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Kecamatan :</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Kabupaten : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Memenuhi yang ditentukan dalam pasal 99 Peraturan
Menteri Agraria / Kepala Badan Pertanahan Nasional Nomor 3 Tahun 1997 yo
Peraturan Pemerintah Nomor 24 Tahun 1997, selaku Calon Penerima Hak ( Pembeli / Penerima Hibah / Pemenang Lelang *)
atas tanah pertanian yang tersebut pada sertifikat Hak Milik</span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">/Buku C. Desa/Girik</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">
Nomor : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">................... (SK. Kinag Jatim Nomor: I/AGR/..../HM/III/1964)
</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Luas : </span><b><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">......................</span></b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> M2<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Atas nama : ...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">Terletak di Desa ...............................,
Kecamatan ............................, Kabupaten Lamongan<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Dengan
batas-batas : <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Utara :
</span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Timur :
</span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Selatan :
</span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 72.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Barat :
</span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">...............................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 63.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Menyatakan bahwa :<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo1; tab-stops: list 54.0pt left 63.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Dengan
pemindahan Hak tersebut tidak menjadi pemegang hak atas tanah yang melebihi
ketentuan batas maksimum penguasaan tanah menurut ketentuan perundangan yang
berlaku <o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo1; tab-stops: list 54.0pt left 63.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Dengan
pemindahan hak tersebut tidak menjadi pemegang hak atas tanah absente (guntai)
menurut ketentuan perundangan yang berlaku<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo1; tab-stops: list 54.0pt left 63.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Apabila
pernyataan pada butir 1 dan 2 ternyata tidak benar, maka tanah kelebihan atas
tanah absente tersebut menjadi obyek landreform.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 54.0pt; mso-list: l0 level1 lfo1; tab-stops: list 54.0pt left 63.0pt; text-align: justify; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Kami
bersedia menanggung semua akibat hukum, apabila pernyataan pada butir 1 dan 2
ternyata tidak benar.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-left: 36.0pt; tab-stops: 63.0pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;"> Demikian
Surat Pernyataan ini kami buat dengan benar dan sesungguhnya untuk dipergunakan
sebagaimana mestinya.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: 266.25pt center 375.65pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> ....................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">,
Tanggal </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;">......................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: center 375.65pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%;">Yang
menyatakan </span><span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"><o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: center 375.65pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: center 375.65pt; text-align: justify;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; tab-stops: center 375.65pt; text-align: justify;">
<br /></div>
<br />
<div class="MsoNormal" style="line-height: 150%; tab-stops: center 375.65pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 11.0pt; line-height: 150%; mso-ansi-language: IN;"> ...............................</span><b><u><span lang="EN-US" style="font-family: "Bookman Old Style","serif";"> </span></u></b><b><u><span style="font-family: "Bookman Old Style","serif"; mso-ansi-language: IN;"><o:p></o:p></span></u></b></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-43988302725784819222015-09-24T18:07:00.003-07:002015-10-03T05:52:48.005-07:00SURAT KETERANGAN WARISAN YANG DIBUAT OLEH PARA AHLI WARIS<div align="right" class="MsoNoSpacing" style="line-height: 115%; text-align: right;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 10.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Psl. 111 (1c4) Permenag/ KaBPN 3/ 97</span><span style="font-family: "Bookman Old Style","serif"; font-size: 10.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div align="right" class="MsoNoSpacing" style="line-height: 115%; text-align: right;">
<br /></div>
<div align="center" class="MsoNoSpacing" style="line-height: 115%; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 14.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">SURAT KETERANGAN WARISAN</span></u></b><b><u><span style="font-family: "Bookman Old Style","serif"; font-size: 14.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></u></b></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-top: 6.0pt; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Kami yang bertanda tangan di bawah ini, para ahli waris
dari almarhum ----......................................... menerangkan dengan
sesungguhnya dengan sanggup diangkat sumpah, bahwa .............................................
Tempat tinggal terakhir di Desa ............................ Kecamatan ...................................
Kabupaten Lamongan, pada tahun ............... telah meninggal dunia di Desa ...........................................
Kecamatan ............................... Kabupaten Lamongan.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; text-align: justify; text-indent: 36.0pt;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">D</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">ari perkawinan</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">....................................................
</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">dengan </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Istr</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">i</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">/suami</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">nya bernama </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">..................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">, telah dilahirkan :</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">...................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> orang anak, yakni:</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-top: 6.0pt; tab-stops: dotted 489.05pt;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.........................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-top: 6.0pt; tab-stops: dotted 489.05pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Bahwa selain kami tersebut di atas
tidak ada lagi ahli waris yang lain.</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: dotted 489.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Dan apabila dikemudian hari surat keterangan waris ini tidak benar karena ---keterangan
kami para ahli waris atau pernyataan kami para ahli waris, maka -----segala
akibat hukumnya baik pidana maupun perdata sepenuhnya menjadi ----tanggung
jawab kami para ahli waris sendiri. Tanpa melibatkan pihak manapun.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: dotted 489.05pt; text-align: justify;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Demikian
kami </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.......................
</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">yang
tersebut diatas adalah </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">para </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">ahli waris dari </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">---</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">almarhum </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: dotted 489.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">
<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 219.75pt dotted 489.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> .....................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> <span lang="EN-US"> tgl </span></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">................................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 219.75pt dotted 489.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">Para ahli waris tersebut di atas :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 219.75pt dotted 489.05pt; text-align: justify;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 155.95pt; margin-right: 0cm; margin-top: 12.0pt; mso-list: l1 level1 lfo1; tab-stops: 347.3pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">......................................... (.............................)</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 155.95pt; margin-right: 0cm; margin-top: 12.0pt; mso-list: l1 level1 lfo1; tab-stops: 347.3pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">......................................... (.............................)</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 155.95pt; margin-right: 0cm; margin-top: 12.0pt; mso-list: l1 level1 lfo1; tab-stops: 347.3pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">3.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">......................................... (.............................)</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 155.95pt; margin-right: 0cm; margin-top: 12.0pt; mso-list: l1 level1 lfo1; tab-stops: 347.3pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">4.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; font-weight: normal; line-height: normal;">
</span></span></b><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">......................................... (.............................)</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: 347.3pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-top: 6.0pt; tab-stops: 347.3pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> Saksi-Saksi
:<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l0 level1 lfo2; tab-stops: 99.25pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">................................. </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">( </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">)<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; tab-stops: 99.25pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; margin-left: 21.3pt; mso-list: l0 level1 lfo2; tab-stops: 99.25pt; text-indent: -18.0pt;">
<!--[if !supportLists]--><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Bookman Old Style"; mso-fareast-font-family: "Bookman Old Style";">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal; line-height: normal;">
</span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">................................. </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";">( )<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> No.
…………………………………………. No. </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.......................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.....................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> <span lang="EN-US"> tgl. ………………….. </span></span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.......................,</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> tgl. </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">............................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> Dikuatkan
oleh kami, disahkan
dan Dibenarkan oleh kami :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> Camat</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> Kepala
Desa</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">...................<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 12.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 12.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 12.0cm;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> <o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 12.0cm;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 361.5pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> </span><u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">................................</span></u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-bidi-font-family: "Times New Roman";"> </span><u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">....................................</span></u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<br />
<div class="MsoNoSpacing" style="line-height: 115%; tab-stops: center 4.0cm 13.0cm;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">.<u><o:p></o:p></u></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-30583517153860702372015-09-24T16:05:00.002-07:002015-10-03T05:53:43.660-07:00SURAT KETERANGAN KEMATIAN<div align="right" class="MsoNoSpacing" style="line-height: 115%; text-align: right;">
<b><span lang="EN-US" style="font-family: "Times New Roman","serif";">Psl.
111 (1.b) PMNA/KBPN 3/’97<o:p></o:p></span></b></div>
<div align="right" class="MsoNoSpacing" style="line-height: 115%; text-align: right;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: -30.65pt; margin-top: 0cm; text-align: center;">
<v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f">
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</o:lock></v:path></v:stroke></v:shapetype><v:shape id="Picture_x0020_2" o:spid="_x0000_s1027" style="height: 74.7pt; left: 0; margin-left: 3.45pt; margin-top: .75pt; mso-height-percent: 0; mso-height-percent: 0; mso-height-relative: page; mso-position-horizontal-relative: text; mso-position-horizontal: absolute; mso-position-vertical-relative: text; mso-position-vertical: absolute; mso-width-percent: 0; mso-width-percent: 0; mso-width-relative: page; mso-wrap-distance-bottom: 0; mso-wrap-distance-left: 9pt; mso-wrap-distance-right: 9pt; mso-wrap-distance-top: 0; mso-wrap-style: square; position: absolute; text-align: left; visibility: visible; width: 61.25pt; z-index: -251657728;" type="#_x0000_t75">
<v:imagedata o:title="" src="file:///C:\Users\ACER\AppData\Local\Temp\msohtmlclip1\01\clip_image001.jpg">
</v:imagedata></v:shape><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 16.0pt; line-height: 115%;">PEMERINTAH
KABUPATEN LAMONGAN<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 134.7pt 262.25pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> KECAMATAN : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN;">................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: 0cm; margin-top: 0cm; tab-stops: 134.7pt 262.25pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> DESA/KELURAHAN : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%; mso-ansi-language: IN;">................................<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 6.0pt; tab-stops: 134.7pt 262.25pt;">
<br /></div>
<br clear="ALL" />
<br />
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 7.1pt; text-align: center;">
<b><u><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;">SURAT
KETERANGAN KEMATIAN<o:p></o:p></span></u></b></div>
<div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Nomor
: </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">......................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;"><o:p></o:p></span></div>
<div align="center" class="MsoNoSpacing" style="line-height: 150%; text-align: center;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 36.0pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Yang
bertanda tangan dibawah ini Kepala Desa/ Lurah</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">.........................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Kecamatan </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Kabupaten lamongan menerangkan bahwa :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Nama : </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Tempat
tinggal lahir :<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Desa/ Kelurahan :</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Kecamatan : </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Kabupaten :<b> </b></span><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span></b><b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">LAMONGAN</span></b><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Telah
meninggal dunia di<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Desa/ kelurahan </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">:
</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Kecamatan : </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 78.0pt 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> Kabupaten :<b> LAMONGAN</b><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 4.0cm 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Pada : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">tahun</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; margin-left: 35.45pt; tab-stops: 4.0cm 191.4pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Karena : </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">Sakit<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; text-align: justify; text-indent: 35.45pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">Demikian
Surat Keterangan ini kami buat dengan benar dan sesungguhnya mengingat sumpah
jabatan, untuk dipergunakan mestinya.<o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">............................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"> </span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";">, tgl </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> <b>KEPALA DESA</b></span><b><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";">/LURAH<o:p></o:p></span></b></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<br /></div>
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<br /></div>
<br />
<div class="MsoNoSpacing" style="line-height: 150%; tab-stops: center 333.15pt;">
<span lang="EN-US" style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-bidi-font-family: "Times New Roman";"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN;">................................</span><b><u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%; mso-ansi-language: IN; mso-bidi-font-family: "Times New Roman";"><o:p></o:p></span></u></b></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-23463109549029450522015-09-24T16:01:00.002-07:002015-10-03T05:54:14.022-07:00SURAT PERNYATAAN SSB-PAJAK KURANG BAYAR<div class="MsoNormal" style="margin-bottom: 6.0pt; tab-stops: 134.7pt 262.25pt;">
<br /></div>
<div align="center" class="MsoNormal" style="margin-bottom: 6.0pt; tab-stops: 7.1pt; text-align: center;">
<b><u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;">SURAT
PERNYATAAN<o:p></o:p></span></u></b></div>
<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 7.1pt; text-align: center;">
<br /></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: -6.8pt; margin-top: 0cm; tab-stops: 35.45pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 14.0pt; line-height: 150%;"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Yang
bertanda tangan di bawah ini, Saya:<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: -6.8pt; margin-top: 0cm; tab-stops: 127.6pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Nama :
................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: -6.8pt; margin-top: 0cm; tab-stops: 127.6pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Tempat/Tgl. Lahir :
................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: -6.8pt; margin-top: 0cm; tab-stops: 127.6pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Alamat :
................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 0cm; margin-right: -6.8pt; margin-top: 0cm; tab-stops: 127.6pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;"> KABUPATEN LAMONGAN.<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 35.45pt right dotted 467.8pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Menyatakan
bahwa, dengan adanya Peralihan Hak atas tanah yang saya miliki berdasarkan Akta
Jual Beli Nomor: ................<o:p></o:p></span></div>
<div class="MsoNormal" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; tab-stops: 35.45pt right dotted 467.8pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">tertanggal
................, Yang terletak di Desa ................, kecamatan ................,
Kabupaten Lamongan maka, saya sanggup membayar apabila SSB kurang Bayar.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="line-height: 150%; margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 21.3pt; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 35.45pt right dotted 467.8pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="line-height: 150%; margin-bottom: 12.0pt; margin-left: 0cm; margin-right: 0cm; margin-top: 0cm; mso-add-space: auto; tab-stops: 35.45pt right dotted 467.8pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Demikian
Surat Keterangan ini kami buat dengan benar, untuk dipergunakan sebagaimana
mestinya.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: 35.45pt right dotted 467.8pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> ...................... Tgl, ................<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> Yang
Menyatakan<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> <b><u>SRI INDAWATI</u></b><o:p></o:p></span></div>
<br />
<div class="MsoListParagraphCxSpLast" style="margin-bottom: .0001pt; margin: 0cm; mso-add-space: auto; tab-stops: center 326.05pt; text-align: justify;">
<br /></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-28283307679443620102015-09-24T15:57:00.001-07:002015-10-03T05:54:34.744-07:00SURAT KUASA DI BAWAH TANGAN UNTUK PENANDATANGAN AKTA (PIHAK PEMBELI)<div align="center" class="MsoNormal" style="text-align: center;">
<b><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">SURAT KUASA PENANDATANGANAN AKTA<o:p></o:p></span></b></div>
<div class="MsoNormal" style="margin-bottom: 12pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Yang bertanda
tangan di bawah ini :<br />
<br />
- Nama : ..............<br />
Tempat/Tgl Lahir : ..............<br />
Alamat : ..............<br />
. ..............<br />
KTP Nomor : ..............<br />
Selaku Pemberi kuasa selanjutnya
disebut sebagai PIHAK PERTAMA.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 12pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Dalam hal
ini memberi kuasa kepada :<br />
- Nama :
..............<br />
Tempat/Tgl Lahir : ..............<br />
Alamat : ..............<br />
. ..............<br />
KTP Nomor : ..............<br />
selaku Penerima Kuasa selanjutnya
disebut Sebagai PIHAK KEDUA.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 12pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
---------------------------------------------- K H U S U S -------------------------------------------------<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpFirst" style="margin: 0cm 0cm 12pt 21.3pt; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">1.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Mewakili dan
bertindak untuk dan atas nama Pemberi Kuasa guna menandatangani Transaksi Jual
Beli dengan Objek Sertipikat Hak Milik nomor <b>.........................</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 12pt 21.3pt; text-align: justify;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Atas nama : <b>................................................</b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 12pt 21.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Surat Ukur
tanggal : <b>.............</b>, Nomor : <b>..........................</b>,
seluas : <b>................... M<sup>2</sup></b><o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 12pt 21.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">yang
terletak di Desa Pangkatrejo, Kecamatan maduran di hadapan Pejabat Pembuat Akta
Tanah.<o:p></o:p></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin: 0cm 0cm 12pt 21.3pt;">
<br /></div>
<div class="MsoListParagraphCxSpLast" style="margin: 0cm 0cm 12pt 21.3pt; text-indent: -18pt;">
<!--[if !supportLists]--><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">2.<span style="font-family: 'Times New Roman'; font-size: 7pt; font-stretch: normal;"> </span></span><!--[endif]--><span dir="LTR"></span><span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Menghadap Pejabat
Pembuat Akta Tanah, memberikan keterangan-keterangan, membuat/suruh membuat,
menandatangani akta-akta atau surat-surat yang diperlukan, membayar semua
administrasi yang berhubungan dengan Transaksi Jual Beli tersebut termasuk
membayar Pajak.<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div class="MsoNormal" style="margin: 0cm 0cm 12pt 3.3pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;">Demikian Surat Kuasa ini diberikan untuk dipergunakan
di mana perlu dan menurut yang semestinya. <br />
<br />
Lamongan,
.........................<br />
<br />
Penerima Kuasa
Pemberi Kuasa<br />
<br />
<br />
<!--[if !supportLineBreakNewLine]--><br />
<!--[endif]--><o:p></o:p></span></div>
<div align="center" class="MsoNormal" style="margin-bottom: 0.0001pt; text-align: center;">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"> Meterai Rp.6000,-<o:p></o:p></span></div>
<br />
<div class="MsoNormal">
<span style="font-family: "Times New Roman","serif"; font-size: 12.0pt; line-height: 107%; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: IN;"><br />
<br />
(………………………….....…)
(....……………..……………)</span><span style="font-size: 12.0pt; line-height: 107%;"><o:p></o:p></span></div>
Anonymoushttp://www.blogger.com/profile/18105949776681062805noreply@blogger.com0tag:blogger.com,1999:blog-8544723909866981672.post-16736025115161241012015-09-23T20:46:00.001-07:002015-10-03T05:55:04.029-07:00SURAT KETERANGAN BUKU C. DESA TIDAK ADA KOP C./RUSAK<div align="center" class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0cm; margin-left: 14.2pt; margin-right: -30.65pt; margin-top: 0cm; text-align: center;">
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</v:imagedata></v:shape><b><span style="font-family: "Bookman Old Style","serif"; font-size: 16.0pt; line-height: 115%;">PEMERINTAH KABUPATEN
LAMONGAN<o:p></o:p></span></b></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> KECAMATAN : .............................<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> DESA/KELURAHAN : .............................<o:p></o:p></span></div>
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<b><u><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;">SURAT
KETERANGAN<o:p></o:p></span></u></b></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;">Nomor : ......................................<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 14.0pt; line-height: 115%;"> </span><span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;">Yang bertanda tangan
di bawah ini Kepala Desa/Lurah:<b> </b>..........................<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Kecamatan
......................... Kabupaten Lamongan. <o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Menerangkan
bahwa, Keadaan Buku C desa yang ada pada Kantor Desa ..........................
seperti halnya pada Buku C. Desa Nomor ............... atas nama ............................
(tanpa KOP C. Desa), dikarenakan keadaan Buku C. Desa yang ada pada Kantor Desa
............................. sudah rusak.<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 150%;">Demikian
Surat Keterangan ini kami buat dengan benar, untuk dipergunakan sebagaimana
mestinya.<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> .........................
Tgl, .................<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> Kepala
Desa ............................<o:p></o:p></span></div>
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<span style="font-family: "Bookman Old Style","serif"; font-size: 12.0pt; line-height: 115%;"> <b><u>................................</u></b><o:p></o:p></span></div>
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