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Perbup Tnd Bangli Terbaru

Perbup Tnd Bangli Terbaru

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BUPATI BANGLI

PERATURAN BUPATI BANGLI
NOMOR 47 TAHUN 2011
TENTANG
PEDOMAN TATA NASKAH DINAS DI LINGKUNGAN
PEMERINTAH KABUPATEN BANGLI
DENGAN RAHMAT TUHAN YANG MAHA ESA
BUPATI BANGLI,
Menimban ! a" ba#$a %a&am 'an(a e)i*ien*i %an e)e(+i)i+a* A%mini*+'a*i
Pen,e&ena'aan Peme'in+a#an Dae'a#, -e'&. -en,e'aaman
Ta+a Na*(a# Dina* %i &in(.nan Peme'in+a# Kab.-a+en Ban&i/
b" ba#$a Pe'a+.'an B.-a+i Ban&i N0m0' 41 Ta#.n 2007 +en+an
Pe%0man Ta+a Na*(a# Dina* Di &in(.nan Peme'in+a#
Kab.-a+en Ban&i +i%a( *e*.ai &ai %enan -e'(embanan
(ea%aan, *e#ina -e'&. %ian+i/
2" ba#$a be'%a*a'(an -e'+imbanan *ebaaimana %ima(*.%
%a&am #.'.) a %an #.'.) b, -e'&. mene+a-(an Pe'a+.'an B.-a+i
Ban&i +en+an Pe%0man Ta+a Na*(a# Dina* %i Lin(.nan
Peme'in+a# Kab.-a+en Ban&i/
Menina+ ! 1" Un%an3Un%an N0m0' 41 Ta#.n 1156 +en+an Pemben+.(an
Dae'a#3%ae'a# Tin(a+ II %a&am 7ia&a,a# Dae'a#3%ae'a#
Tin(a+ I Ba&i, N.*a Tena'a Ba'a+ %an N.*a Tena'a Tim.'
8Lemba'an Nea'a Re-.b&i( In%0ne*ia Ta#.n 1156 N0m0' 122,
Tamba#an Lemba'an Nea'a Re-.b&i( In%0ne*ia N0m0' 14559/
2" Un%an3Un%an N0m0' 10 Ta#.n 2004 +en+an Pemben+.(an
Pe'a+.'an Pe'.n%an3.n%anan 8Lemba'an Nea'a Re-.b&i(
In%0ne*ia Ta#.n 2004 N0m0' 5:, Tamba#an Lemba'an Nea'a
N0m0' 4:619/
:" Un%an3Un%an N0m0' :2 Ta#.n 2004 +en+an Peme'in+a#an
Dae'a# 8Lemba'an Nea'a Re-.b&i( In%0ne*ia Ta#.n 2004
N0m0' 125, Tamba#an Lemba'an Nea'a Re-.b&i( In%0ne*ia
N0m0' 44:79, *ebaaimana +e&a# %i.ba# bebe'a-a (a&i, +e'a(#i'
%enan Un%an3Un%an N0m0' 12 Ta#.n 2006 +en+an
Pe'.ba#an Ke%.a A+a* Un%an3Un%an N0m0' :2 Ta#.n 2004
+en+an Peme'in+a#an Dae'a# 8Lemba'an Nea'a Re-.b&i(
In%0ne*ia Ta#.n 2006 N0m0' 51, Tamba#an Lemba'an Nea'a
Re-.b&i( In%0ne*ia N0m0' 46449/
4" Pe'a+.'an Peme'in+a# N0m0' 44 Ta#.n 1151 +en+an Lamban
Nea'a 8Lemba'an Nea'a Re-.b&i( In%0ne*ia Ta#.n 1151
N0m0' 111, Tamba#an Lemba'an Nea'a Re-.b&i( In%0ne*ia
N0m0' 1749/
5" Pe'a+.'an Peme'in+a# N0m0' 4: Ta#.n 1156 +en+an
Pen.naan Lamban Nea'a 8Lemba'an Nea'a Re-.b&i(
In%0ne*ia Ta#.n 1156 N0m0' 1171, Tamba#an Lemba'an
Nea'a Re-.b&i( In%0ne*ia N0m0' 14:49/
4" Pe'a+.'an Peme'in+a# N0m0' :6 Ta#.n 2007 +en+an
Pembaian U'.*an An+a'a Peme'in+a#, Peme'in+a#an Dae'a#
P'0;in*i %an Peme'in+a#an Kab.-a+en<K0+a Ma%,a 8Lemba'an
Nea'a Re-.b&i( In%0ne*ia Ta#.n 2007 N0m0' 62, Tamba#an
Lemba'an Nea'a Re-.b&i( In%0ne*ia N0m0' 47:79/
7" Pe'a+.'an Peme'in+a# N0m0' 41 Ta#.n 2007 +en+an
O'ani*a*i Pe'an(a+ Dae'a# 8Lemba'an Nea'a Re-.b&i(
In%0ne*ia Ta#.n 2007 N0m0' 61, Tamba#an Lemba'an Nea'a
Re-.b&i( In%0ne*ia N0m0' 47419/
6" Pe'a+.'an Men+e'i Da&am Nee'i N0m0' 54 Ta#.n 2001 +en+an
Ta+a Na*(a# Dina* Di Lin(.nan Peme'in+a# Dae'a#/
1" Pe'a+.'an Dae'a# Kab.-a+en Ban&i N0m0' 1 Ta#.n 2011"
+en+an Ana'an Pen%a-a+an Be&an=a Dae'a# Ta#.n
Ana'an 2011 8Lemba'an Dae'a# Kab.-a+en Ban&i N0m0' 19/
10" Pe'a+.'an B.-a+i Ban&i N0m0' : Ta#.n 2011 +en+an
Pen=aba'an Ana'an Pen%a-a+an Be&an=a Dae'a# Ta#.n
Ana'an 2011 8Be'i+a Dae'a# Kab.-a+en Ban&i Ta#.n 2011
N0m0' :9"
MEMUTUSKAN !
Mene+a-(an ! PERATURAN BUPATI BANGLI TENTANG PEDOMAN TATA
NASKAH DINAS DI LINGKUNGAN PEMERINTAH KABUPATEN
BANGLI"
BAB I
KETENTUAN UMUM
Pa*a& 1
Da&am Pe'a+.'an B.-a+i ini, ,an %ima(*.% %enan!
1" Kab.-a+en a%a&a# Kab.-a+en Ban&i
2" Peme'in+a# Kab.-a+en a%a&a# Peme'in+a# Kab.-a+en Ban&i
:" B.-a+i a%a&a# B.-a+i Ban&i
4" 7a(i& B.-a+i a%a&a# 7a(i& B.-a+i Ban&i
5" Se('e+a'i* Dae'a# *e&an=.+n,a %i*eb.+ Se(%a a%a&a# Se('e+a'i* Dae'a#
Kab.-a+en Ban&i"
4" Pe'an(a+ Dae'a# a%a&a# .n*.' -emban+. B.-a+i %a&am -en,e&ena'aan
-eme'in+a# %ae'a# ,an +e'%i'i %a'i *e('e+a'ia+ %ae'a#, *e('e+a'ia+ DPRD, %ina*
%ae'a#, &embaa +e(ni* %ae'a#, (e2ama+an, (e&.'a#an %an &embaa &ain"
7" Sa+.an Ke'=a Pe'an(a+ Dae'a# *e&an=.+n,a %i*in(a+ SKPD a%a&a# Sa+.an
Ke'=a Pe'an(a+ Dae'a# Kab.-a+en Ban&i"
6" Sa+.an Ke'=a Pe'an(a+ Dae'a# Kab.-a+en Ban&i *e&an=.+n,a %i*eb.+ SKPD
Kab.-a+en Ban&i a%a&a# *e('e+a'ia+ %ae'a#, *e('e+a'ia+ DPRD, %ina* %ae'a#,
&embaa +e(ni* %ae'a#, (e2ama+an, (e&.'a#an %an &embaa &ain"
1" Uni+ -e&a(*ana +e(ni* *e&an=.+n,a %i*eb.+ UPT a%a&a# .n*.' -e&a(*ana +e(ni*
%ina* a+a. ba%an .n+.( me&a(*ana(an *ebaian .'.*an %ina* a+a. ba%an"
10" Ta+a na*(a# %ina* a%a&a# -ene&0&aan in)0'ma*i +e'+.&i* ,an me&i-.+i
-ena+.'an =eni*, )0'ma+, -en,ia-an, -enamanan, -enab*a#an, %i*+'ib.*i
%an -en,im-anan na*(a# %ina* *e'+a me%ia ,an %i.na(an %a&am
(0m.ni(a*i (e%ina*an"
11" Na*(a# %ina* a%a&a# in)0'ma*i +e'+.&i* *ebaai a&a+ (0m.ni(a*i (e%ina*an ,an
%ib.a+ %an<a+a. %i(e&.a'(an 0&e# -e=aba+ ,an be'$enan %i &in(.nan
-eme'in+a# %ae'a#"
12" >0'ma+ a%a&a# na*(a# %ina* ,an menamba'(an +a+a &e+a( %an 'e%a(*i0na&,
*e'+a -en.naan &amban<&00 %an 2a- %ina*"
1:" S+em-e&<2a- %ina* a%a&a# +an%a i%en+i+a* %a'i *.a+. =aba+an a+a. SKPD"
14" K0- na*(a# %ina* a%a&a# (0- *.'a+ ,an men.n=.(an =aba+an a+a. nama
SKPD +e'+en+. ,an %i+em-a+(an %ibaian a+a* (e'+a*"
15" K0- *am-.& na*(a# %ina* a%a&a# (0- *.'a+ ,an men.n=.(an =aba+an a+a.
nama SKPD +e'+en+. ,an %i+em-a+(an %ibaian a+a* *am-.& na*(a#"
14" Ke$enanan a%a&a# (e(.a*aan ,an me&e(a+ -a%a *.a+. =aba+an"
17" De&ea*i a%a&a# -e&im-a#an $e$enan %an +an.n =a$ab %a'i -e=aba+
(e-a%a -e=aba+ a+a. -e=aba+ %iba$a#n,a"
16" Man%a+ a%a&a# -e&im-a#an $e$enan ,an %ibe'i(an 0&e# a+a*an (e-a%a
ba$a#an .n+.( me&a(.(an *.a+. +.a* +e'+en+. a+a* nama ,an membe'i
man%a+"
11" Penan%a+ananan na*(a# %ina* a%a&a# #a(, (e$a=iban %an +an.n=a$ab
,an a%a -a%a *e0'an -e=aba+ .n+.( menan%a+anani na*(a# %ina* *e*.ai
%enan +.a* %an (e$enanan -a%a =aba+ann,a"
20" Pe'a+.'an Dae'a# a%a&a# na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.(
#.(.m, ,an be'*i)a+ -ena+.'an %i+e+a-(an 0&e# Ke-a&a Dae'a# *e+e&a#
men%a-a+ -e'*e+.=.an be'*ama De$an Pe'$a(i&an Ra(,a+ Dae'a# .n+.(
mena+.' .'.*an O+0n0mi Dae'a# %an +.a* Pemban+.an"
21" Pe'a+.'an B.-a+i a%a&a# na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.(
#.(.m ,an be'*i)a+ -ena+.'an %i+e+a-(an 0&e# B.-a+i"
22" Pe'a+.'an be'*ama a%a&a# na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.(
#.(.m ,an be'*i)a+ -ena+.'an %i+e+a-(an 0&e# %.a a+a. &ebi# (e-a&a %ae'a#"
2:" Ke-.+.*an B.-a+i a%a&a# na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.(
#.(.m ,an be'*i)a+ -ene+a-an (0n('i+, in%i;i%.a&, %an )ina&"
24" Ke-.+.*an Ke-a&a SKPD a%a&a# na*(a# %ina* %a&am ben+.( %an *.*.nan
-'0%.( #.(.m ,an be'*i)a+ -ene+a-an, in%i;i%.a&, (0n('i+ %an )ina&"
25" In*+'.(*i B.-a+i a%a&a# na*(a# %ina* ,an be'i*i(an -e'in+a# %a'i B.-a+i
(e-a%a ba$a#an .n+.( me&a(*ana(an +.a*3+.a* -eme'in+a#an"
24" S.'a+ e%a'an a%a&a# na*(a# %ina* ,an be'i*i -embe'i+a#.an, -en=e&a*an
%an<a+a. -e+.n=.( 2a'a me&a(*ana(an #a& +e'+en+. ,an %iana- -en+in %an
men%e*a("
27" S.'a+ bia*a a%a&a# na*(a# %ina* ,an be'i*i -embe'i+a#.an, -e'+an,aan,
-e'min+aan =a$aban a+a. *a'an %an *ebaain,a"
26" S.'a+ Ke+e'anan a%a&a# na*(a# %ina* ,an be'i*i -e'n,a+aan +e'+.&i* %a'i
-e=aba+ *ebaai +an%a b.(+i .n+.( mene'an(an a+a. men=e&a*(an (ebena'an
*e*.a+. #a&"
21" S.'a+ Pe'in+a# a%a&a# na*(a# %ina* %a'i a+a*an ,an %i+.=.(an (e-a%a
ba$a#an ,an be'i*i -e'in+a# .n+.( me&a(*ana(an -e(e'=aaan +e'+en+."
:0" S.'a+ I?in a%a&a# na*(a# %ina* ,an be'i*i -e'*e+.=.an +e'#a%a- *.a+.
-e'm0#0nan ,an %i(e&.a'(an 0&e# -e=aba+ ,an be'$enan"
:1" S.'a+ Pe'=an=ian a%a&a# na*(a# %ina* ,an be'i*i (e*e-a(a+an be'*ama an+a'a
%.a be&a# -i#a( a+a. &ebi# .n+.( me&a(*ana(an +in%a(an a+a. -e'b.a+an
#.(.m ,an +e&a# %i*e-a(a+i be'*ama"
:2" S.'a+ Pe'in+a# +.a* a%a&a# na*(a# %ina* %a'i a+a*an ,an %i+.=.(an (e-a%a
ba$a#an ,an be'i*i -e'in+a# .n+.( me&a(*ana(an -e(e'=aan *e*.ai %enan
+.a* %an ).n*in,a"
::" S.'a+ Pe'in+a# -e'=a&anan %ina* a%a&a# na*(a# %ina* %a'i -e=aba+ ,an
be'$enan (e-a%a ba$a#an a+a. -e=aba+ +e'+en+. .n+.( me&a(*ana(an
-e'=a&anan %ina*"
:4" S.'a+ K.a*a a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan (e-a%a
ba$a#an be'i*i -embe'ian $e$enan %enan a+a* naman,a .n+.( me&a(.(an
*.a+. +in%a(an +e'+en+. %a&am 'an(a (e%ina*an"
:5" S.'a+ Un%anan a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i
.n%anan (e-a%a -e=aba+<-ea$ai ,an +e'*eb.+ -a%a a&ama+ +.=.an .n+.(
men#a%i'i *.a+. a2a'a (e%ina*an"
:4" S.'a+ Ke+e'anan me&a(*ana(an T.a* a%a&a# na*(a# %ina* %a'i -e=aba+ ,an
be'$enan be'i*i -e'n,a+aan ba#$a *e0'an -ea$ai +e&a# men=a&an(an
+.a*"
:7" S.'a+ Pani&an a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i
-ani&an (e-a%a *e0'an -ea$ai .n+.( men#a%a-"
:6" N0+a Dina* a%a&a# na*(a# %ina* ,an be'*i)a+ in+e'na& be'i*i (0m.ni(a*i
(e%ina*an an+a' -e=aba+ a+a. %a'i a+a*an (e-a%a ba$a#an %an %a'i ba$a#an
(e-a%a a+a*an"
:1" N0+a Pena=.an K0n*e- Na*(a# Dina* a%a&a# na*(a# %ina* .n+.(
men,am-ai(an (0n*e- na*(a# %ina* (e-a%a a+a*an"
40" Lemba' Di*-0*i*i a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i
-e+.n=.( +e'+.&i* (e-a%a ba$a#an"
41" Te&aa#an *+a) a%a&a# na*(a# %ina* %a'i ba$a#an (e-a%a a+a*an an+a'a &ain
be'i*i ana&i*i* -e'+imbanan, -en%a-a+ %an *a'an3*a'an *e2a'a *i*+ema+i*"
42" Pen.m.man a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i
-embe'i+a#.an ,an be'*i)a+ .m.m"
4:" La-0'an a%a&a# na*(a# %ina* %a'i ba$a#an (e-a%a a+a*an ,an be'i*i
in)0'ma*i %an -e'+an.n=a$aban +en+an -e&a(*anaan +.a* (e%ina*an"
44" Re(0men%a*i a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i
(e+e'anan a+a. 2a+a+an +en+an *e*.a+. #a& ,an %a-a+ %i=a%i(an ba#an
-e'+imbanan (e%ina*an"
45" S.'a+ Penan+a' a%a&a# na*(a# %ina* be'i*i =eni* %an =.m&a# ba'an ,an
be').n*i *ebaai +an%a +e'ima"
44" Te&e'am a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i #a& +e'+en+.
,an %i(i'im me&a&.i +e&e(0m.ni(a*i e&e(+'0ni("
47" Lemba'an %ae'a# a%a&a# na*(a# %ina* .n+.( men.n%an(an -e'a+.'an
%ae'a#"
46" Be'i+a %ae'a# a%a&a# na*(a# %ina* .n+.( men.n%an(an -e'a+.'an (e-a&a
%ae'a#"
41" Be'i+a a2a'a a%a&a# na*(a# %ina* ,an be'i*i (e+e'anan a+a* *e*.a+. #a&
,an %i+an%a +anani 0&e# -a'a -i#a("
50" N0+.&en a%a&a# na*(a# %ina* ,an mem.a+ 2a+a+an -'0*e* *i%an a+a. 'a-a+"
51" Mem0 a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i 2a+a+an
+e'+en+."
52" Da)+a' #a%i' a%a&a# na*(a# %ina* %a'i -e=aba+ be'$enan ,an be'i*i
(e+e'anan a+a* (e#a%i'an *e*e0'an"
5:" Piaam a%a&a# na*(a# %ina* %a'i -e=aba+ ,an be'$enan be'i*i -en#a'aan
a+a* -'e*+a*i ,an +e&a# %i2a-ai a+a. (e+e&a%anan ,an +e&a# %i$.=.%(an"
54" S.'a+ +an%a +ama+ -en%i%i(an %an -e&a+i#an %i*in(a+ STTPP a%a&a# na*(a#
%ina* ,an me'.-a(an +an%a b.(+i *e*e0'an +e&a# &.&.* -en%i%i(an %an
-e&a+i#an +e'+en+."
55" Se'+i)i(a+ a%a&a# na*(a# %ina* ,an me'.-a(an +an%a b.(+i *e*e0'an +e&a#
meni(.+i (eia+an +e'+en+."
54" Pe'.ba#an a%a&a# me'.ba# a+a. men,i*i-(an *.a+. na*(a# %ina*"
57" Pen2ab.+an a%a&a# *.a+. -e'n,a+aan +i%a( be'&a(.n,a *.a+. na*(a# %ina*
*e=a( %i+e+a-(an -en2ab.+an +e'*eb.+"
56" Pemba+a&an a%a&a# -e'n,a+aan ba#$a *.a+. na*(a# %ina* %iana- +i%a(
-e'na# %i(e&.a'(an"
BAB II
TATA NASKAH DINAS
Pa*a& 2
A*a* +a+a na*(a# %ina* +e'%i'i a+a*!
a" a*a* e)i*ien %an e)e(+i)/
b" a*a* -emba(.an/
2" a*a* a(.n+abi&i+a*/
%" a*a* (e+e'(ai+an/
e" a*a* (e2e-a+an %an (e+e-a+an/ %an
)" a*a* (eamanan"
Pa*a& :
(1) A*a* e)i*ien %an e)e(+i) *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) a,
%i&a(.(an me&a&.i -en,e%e'#anaan %a&am -en.&i*an, -en.naan '.an a+a.
&emba' na*(a# %ina*, *-e*i)i(a*i in)0'ma*i, *e'+a %a&am -en.naan ba#a*a
In%0ne*ia ,an bai(, bena' %an &.a*"
(2) A*a* -emba(.an *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) b, %i&a(.(an
me&a&.i +a+a2a'a %an ben+.( ,an +e&a# %iba(.(an"
(3) A*a* a(.n+abi&i+a* *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) 2, ,ai+.
-en,e&ena'aan +a+a na*(a# %ina* #a'.* %a-a+ %i-e'+an.n=a$ab(an %a'i
*ei i*i, )0'ma+, -'0*e%.', (e$enanan, (eab*a#an %an %0(.men+a*i"
(4) A*a* (e+e'(ai+an *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) %, ,ai+. +a+a
na*(a# %ina* %i*e&ena'a(an %a&am *a+. (e*a+.an *i*+em"
(5) A*a* (e2e-a+an %an (e+e-a+an *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) e,
,ai+. +a+a na*(a# %ina* %i*e&ena'a(an +e-a+ $a(+. %an +e-a+ *a*a'an"
(6) A*a* (eamanan *ebaaimana %ima(*.% %a&am Pa*a& 2 #.'.) ), ,ai+.
-en,e&ena'aan +a+a na*(a# %ina* #a'.* aman *e2a'a )i*i( %an *.b*+an*i"

Pa*a& 4
P'in*i-3-'in*i- -en,e&ena'aan na*(a# %ina* +e'%i'i a+a*!
a. (e+e&i+ian/
b. (e=e&a*an/
c. *in(a+ %an -a%a+/%an
d. &0i* %an me,a(in(an/
Pa*a& 5
(1) P'in*i- (e+e&i+ian *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) a,
%i*e&ena'a(an *e2a'a +e&i+i %an 2e'ma+ %a'i ben+.(, *.*.nan -ene+i(an, i*i,
*+'.(+.', (ai%a# ba#a*a %an -ene'a-an (ai%a# e=aan %i%a&am -ene+i(an"
(2) P'in*i- (e=e&a*an *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) b,
%i*e&ena'a(an %enan mem-e'#a+i(an (e=e&a*an a*-e( )i*i( %an ma+e'i
%enan men.+ama(an me+0%e ,an 2e-a+ %an +e-a+"
(3) P'in*i- *in(a+ %an -a%a+ *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) 2,
%i*e&ena'a(an %enan men.na(an ba#a*a In%0ne*ia ,an bai( %an bena'"
(4) P'in*i- &0i* %an me,a(in(an *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) %,
%i*e&ena'a(an *e2a'a '.n+.+ %an &0i* %an me,a(in(an *e'+a *+'.(+.' (a&ima+
#a'.* &en(a- %an e)e(+i)"
Pa*a& 4
Pen,e&ena'aan na*(a# %ina* %i&a(*ana(an *ebaai be'i(.+!
a. -ene&0&aan *.'a+ ma*.(/
b. -ene&0&aan *.'a+ (e&.a'/
c. +in(a+ Keamanan/
d. (e2e-a+an -'0*e*/
e. -en.naan (e'+a* *.'a+/
f. -ene+i(an *a'ana a%mini*+'a*i %an (0m.ni(a*i
-e'(an+0'an/ %an
g. $a'na %an (.a&i+a* (e'+a*"
Pa*a& 7
Pene&0&aan *.'a+ ma*.( *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) a, %i&a(.(an
me&a&.i!
a. In*+an*i -ene'ima menin%a(&an=.+i *.'a+ ,an %i+e'ima
me&a&.i +a#a-an!
1. %iaen%a %an %i(&a*i)i(a*i *e*.ai *i)a+ *.'a+ *e'+a %i%i*+'ib.*i(an (e .ni+
-ene&0&a/
2" .ni+ -ene&0&a menin%a(&an=.+i *e*.ai %enan (&a*i)i(a*i *.'a+ %an a'a#an
-im-inan/ %an
3. *.'a+ ma*.( %ia'*i-(an -a%a .ni+ +a+a .*a#a"
b. @0-, *.'a+ =a$aban ,an mem-.n,ai +emb.*an
%i*am-ai(an (e-a%a ,an be'#a("
c. A&.' *.'a+ men,.'a+ %i*e&ena'a(an me&a&.i
me(ani*me %a'i +in(a+ -im-inan +e'+ini #ina (e -e=aba+ *+'.(+.'a& +e'en%a#
,an be'$enan"
Pa*a& 6
Pene&0&aan *.'a+ (e&.a' *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) b, %i&a(.(an
me&a&.i +a#a-an!
a. (0n*e- *.'a+ (e&.a' %i-a'a) *e2a'a be'=en=an %an
+e'(00'%ina*i *e*.ai +.a* %an (e$enanann,a %an %iaen%a(an 0&e# ma*in3
ma*in .ni+ +a+a .*a#a %a&am 'an(a -enen%a&ian/
b. *.'a+ (e&.a' ,an +e&a# %i+an%a+anani 0&e# -e=aba+
,an be'$enan %ibe'i n0m0', +ana& %an *+em-e& 0&e# .ni+ +a+a .*a#a -a%a
ma*in3ma*in *a+.an (e'=a -e'an(a+ %ae'a#/
c. *.'a+ (e&.a' *ebaaimana %ima(*.% -a%a #.'.) b $a=ib
*ee'a %i(i'im/ %an
d. *.'a+ (e&.a' %ia'*i-(an -a%a .ni+ +a+a .*a#a"
Pa*a& 1
Tin(a+ (eamanan *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) 2, %i&a(.(an %enan
men2an+.m(an (0%e -a%a *am-.& na*(a# %ina* *ebaai be'i(.+!
a. *.'a+ *ana+ 'a#a*ia %i*in(a+ SR, me'.-a(an *.'a+
,an ma+e'i %an *i)a+n,a memi&i(i +in(a+ (eamanan ,an +ini, e'a+
#.b.nann,a %enan 'a#a*ia nea'a, (eamanan %an (e*e&ama+an nea'a"
b. *.'a+ 'a#a*ia %i*in(a+ R, me'.-a(an *.'a+ ,an ma+e'i
%an *i)a+n,a memi&i(i +in(a+ (eamanan +ini ,an be'%am-a( (e-a%a (e'.ian
nea'a, %i*in+e'a*i ban*a"
c. *.'a+ -en+in %i*in(a+ P, me'.-a(an *.'a+ ,an +in(a+
(eamanan i*i *.'a+ -e'&. men%a-a+ -e'#a+ian -ene'ima *.'a+"
d. *.'a+ (0n)i%en*ia& %i*in(a+ K, me'.-a(an *.'a+ ,an
ma+e'i %an *i)a+n,a memi&i(i +in(a+ (eamanan *e%an ,an be'%am-a( (e-a%a
+e'#amba+n,a =a&ann,a -eme'in+a#an %an -emban.nan"
e. *.'a+ bia*a %i*in(a+ B, me'.-a(an *.'a+ ,an ma+e'i
%an *i)a+n,a bia*a nam.n +i%a( %a-a+ %i*am-ai(an (e-a%a ,an +i%a( be'#a("
Pa*a& 10
Ke2e-a+an -'0*e* *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) %, *ebaai be'i(.+!
a" ama+ *ee'a<(i&a+, %enan ba+a* $a(+. 24 =am *e+e&a#
*.'a+ %i+e'ima/
b" *ee'a, %enan ba+a* $a(+. 2 A 24 =am *e+e&a# *.'a+
%i+e'ima/
c. -en+in, %enan ba+a* $a(+. : A 24 =am *e+e&a# *.'a+
%i+e'ima/ %an
d. bia*a, %enan ba+a* $a(+. ma(*im.m 5 #a'i (e'=a
*e+e&a# *.'a+ %i+e'ima"
Pa*a& 11
Pen.naan (e'+a* *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) e, *ebaai
be'i(.+!
a. (e'+a* ,an %i.na(an .n+.( na*(a# %ina* a%a&a# HBS
60 'am/
b. -en.naan (e'+a* HBS %ia+a* 60 'am a+a. =eni* &ain,
#an,a +e'ba+a* .n+.( =eni* na*(a# %ina* ,an mem-.n,ai ni&ai (ea*aman
+e'+en+. %an ni&ai (e.naan %a&am $a(+. &ama/
c. -en,e%iaan *.'a+ be'&amban nea'a be'$a'na (.nin
ema* a+a. &00 %ae'a# be'$a'na %i2e+a( %i a+a* (e'+a* 60 'am/
d. .(.'an (e'+a* ,an %i.na(an .n+.( *.'a+3men,.'a+
a%a&a# >0&i0<>4 8215 A ::0 mm9/
e. .(.'an (e'+a* ,an %i.na(an .n+.( ma(a&a#, -i-e' %an
&a-0'an a%a&a# A4 8210 A 217 mm9/ %an
f. .(.'an (e'+a* ,an %i.na(an .n+.( -i%a+0 a%a&a# A5
8145 A 215 mm9"
Pa*a& 12
Pene+i(an *a'ana a%mini*+'a*i %an (0m.ni(a*i -e'(an+0'an %ima(*.% %a&am Pa*a&
4 #.'.) ), *ebaai be'i(.+!
a. -en.naan =eni* #.'.) -i2a/
b" a'ia& 12 a+a. %i*e*.ai(an %enan (eb.+.#an/ %an
c. *-a*i 1 a+a. 1,5 *e*.ai (eb.+.#an"
Pa*a& 1:
7a'na %an (.a&i+a* (e'+a* *ebaaimana %ima(*.% %a&am Pa*a& 4 #.'.) , be'$a'na
-.+i# %enan (.a&i+a* bai("
BAB III
NASKAH DINAS

Baian Ke*a+.
Ben+.( Dan S.*.nan
Pa*a& 14
Ben+.( %an *.*.nan na*(a# %ina* -'0%.( #.(.m %i &in(.nan -eme'in+a#
Kab.-a+en Ban&i, +e'%i'i a+a*!
a" -e'a+.'an Dae'a#/
b" -e'a+.'an B.-a+i/
2" -e'a+.'an be'*ama B.-a+i/ %an
%" (e-.+.*an B.-a+i/
Pa*a& 15
Ben+.( %an *.*.nan na*(a# %ina* *.'a+ %i &in(.nan Peme'in+a# Kab.-a+en
Ban&i, +e'%i'i a+a*!
a" in*+'.(*i/
b" *.'a+ e%a'an/
2" *.'a+ bia*a/
%" *.'a+ (e+e'anan/
e" *.'a+ -e'in+a#/
)" *.'a+ i?in/
" *.'a+ -e'=an=ian/
#" *.'a+ -e'in+a# +.a*/
i" *.'a+ -e'in+a# -e'=a&anan %ina*/
=" *.'a+ (.a*a/
(" *.'a+ .n%anan/
&" *.'a+ (e+e'anan me&a(*ana(an +.a*/
m" *.'a+ -ani&an/
n" n0+a %ina*/
0" n0+a -ena=.an (0n*e- na*(a# %ina*/
-" &emba' %i*-0*i*i/
C" +e&aa#an *+a)/
'" -en.m.man/
*" &a-0'an/
+" 'e(0men%a*i/
." *.'a+ -enan+a'/
;" +e&e'am/
$" &emba'an %ae'a#/
A" be'i+a %ae'a#/
," be'i+a a2a'a/
?" n0+.&en/
aa" mem0/
ab" %a)+a' #a%i'/
a2" -iaam/
a%" *e'+i)i(a+/ %an
ae" STTPP"
BAB IB
PENGGUNAAN DAN KE7ENANGAN
ATAS NAMA, UNTUK BELIAU, PELAKSANA TUGAS, PELAKSANA HARIAN,
DAN PENDABAT
Pa*a& 14
819 A+a* nama ,an %i*in(a+ a"n" me'.-a(an =eni* -e&im-a#an
$e$enan %a&am #.b.nan in+e'na& an+a'a a+a*an (e-a%a -e=aba+ *e+in(a+
%iba$a#n,a"
829 Un+.( be&ia. ,an %i*in(a+ ."b" me'.-a(an =eni*
-e&im-a#an $e$enan %a&am #.b.nan in+e'na& an+a'a a+a*an (e-a%a -e=aba+
%.a +in(a+ %iba$a#n,a"
8:9 Tan.n =a$ab *ebaaimana %ima(*.% -a%a a,a+ 819 %an
a,a+ 829 +e+a- be'a%a -a%a -e=aba+ ,an me&im-a#(an $e$enan %an -e=aba+
,an mene'ima -e&im-a#an $e$enan #a'.* mem-e'+an.n=a$ab(an
(e-a%a -e=aba+ ,an me&im-a#(an $e$enan"

Pa*a& 17
(1) Pe&a(*ana +.a* ,an %i*in(a+ P&+ me'.-a(an
-e=aba+ *emen+a'a -a%a =aba+an +e'+en+. ,an men%a-a+ -e&im-a#an $e$enan
-enan%a+ananan na*(a# %ina*, (a'ena -e=aba+ %e)ini+i) be&.m %i&an+i("
(2) P&+ *ebaaimana %ima(*.% -a%a a,a+ 819 %ian(a+
%enan (e-.+.*an (e-a&a SKPD a+a. (e-.+.*an B.-a+i %an be'&a(. -a&in &ama
1 8*a+.9 +a#.n"
8:9 P&+ *ebaaimana %ima(*.% -a%a a,a+ 819
be'+an.n =a$ab a+a* na*(a# %ina* ,an %i&a(.(ann,a"
Pa*a& 16
(1) Pe&a(*ana +.a* #a'ian ,an %i*in(a+ P&# me'.-a(an -e=aba+ *emen+a'a -a%a
=aba+an +e'+en+. ,an men%a-a+ -e&im-a#an $e$enan -enan%a+ananan
na*(a# %ina*, (a'ena -e=aba+ %e)ini+i) be'#a&anan *emen+a'a"
(2) P&# *ebaaimana %ima(*.% -a%a a,a+ 819 %ian(a+
%enan (e-.+.*an (e-a&a SKPD a+a. (e-.+.*an B.-a+i %an be'&a(. -a&in &ama
: 8+ia9 b.&an"
8:9 P&# *ebaaimana %ima(*.% -a%a a,a+ 819
mem-e'+an.n=a$ab(an -e&a(*anaan a+a* na*(a# %ina* ,an %i&a(.(ann,a
(e-a%a -e=aba+ %e)ini+i)"
Pa*a& 11
(1) Pen=aba+ ,an %i*in(a+ P=" me'.-a(an -e=aba+ *emen+a'a
.n+.( =aba+an B.-a+i"
829 Pen=aba+ *ebaaimana -a%a a,a+ 819 me&a(*ana(an +.a*
-eme'in+a#an -a%a %ae'a# +e'+en+. *am-ai %enan -e&an+i(an -e=aba+ %e)ini+i)"
BAB B
PARA>, PENULISAN NAMA, PENANDATANGANAN,
DAN PENGGUNAAN TINTA UNTUK NASKAH DINAS
Baian Ke*a+.
Pa'a)
Pa*a& 20
819 Se+ia- na*(a# %ina* *ebe&.m %i+an%a+anani +e'&ebi# %a#.&. %i-a'a)"
829 Na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.( #.(.m *ebe&.m
%i+an%a+anani +e'&ebi# %a#.&. %i-a'a) -a%a *e+ia- &emba'"
8:9 Pa'a) *ebaaimana %ima(*.% -a%a a,a+ 819 %an a,a+ 829 %i&a(.(an 0&e# -e=aba+
+e'(ai+ *e2a'a #0'i?0n+a& %an ;e'+i(a&"
(4) Pa'a) *ebaaimana %ima(*.% -a%a a,a+ 819 %an a,a+ 829 me'.-a(an +an%a
+anan *in(a+ *ebaai ben+.( -e'+an.n=a$aban a+a* m.a+an ma+e'i,
*.b*+an*i, 'e%a(*i %an -ene+i(an na*(a# %ina*"
(5) Pa'a) *ebaaimana %ima(*.% -a%a a,a+ 849 me&i-.+i!
a. -a'a) #ie'a'(i/ %an
b" -a'a) (00'%ina*i"
Baian Ke%.a
Pen.&i*an Nama
Pa*a& 21
(1) Pen.&i*an nama B.-a+i %an $a(i& B.-a+i -a%a na*(a# %ina*!
a" %a&am ben+.( %an *.*.nan -'0%.( #.(.m +i%a( men.na(an e&a'/ %an
b" %a&am ben+.( %an *.*.nan *.'a+ men.na(an e&a'"
829 Pen.&i*an nama -e=aba+ *e&ain ,an %ima(*.% -a%a a,a+ 819 men.na(an
e&a', n0m0' in%.( -ea$ai %an -an(a+
Baian Ke+ia
Penan%a+ananan na*(a# %ina*
%i &in(.nan -eme'in+a# Kab.-a+en
Pa*a& 22
819 B.-a+i menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.( #.(.m
*ebaaimana %ima(*.% %a&am Pa*a& 14 +e'%i'i a+a*!
a" -e'a+.'an %ae'a#/
b" -e'a+.'an B.-a+i/
2" -e'a+.'an be'*ama B.-a+i/ %an
%" (e-.+.*an B.-a+i"
829 B.-a+i menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+
*ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" in*+'.(*i/
b" *.'a+ e%a'an/
2" *.'a+ bia*a/
%" *.'a+ (e+e'anan/
e" *.'a+ -e'in+a#/
)" *.'a+ i?in/
" *.'a+ -e'=an=ian/
#" *.'a+ -e'in+a# +.a*/
i" *.'a+ (.a*a/
=" *.'a+ .n%anan/
(" *.'a+ (e+e'anan me&a(*ana(an +.a*/
&" *.'a+ -ani&an/
m" n0+a %ina*/
n" &emba' %i*-0*i*i/
0" -en.m.man/
-" &a-0'an/
C" 'e(0men%a*i/
'" +e&e'am/
*" be'i+a a2a'a/
+" mem0/
." -iaam/
;" *e'+i)i(a+/ %an
$" STTPP"
Pa*a& 2:
819 B.-a+i men%e&ea*i(an -enan%a+ananan -e'i?inan %ibi%an -e&a,anan ,an
be'*i)a+ &in+a* *e(+0' (e-a%a SKPD ,an membi%ani -e&a,anan -e'i?inan
+e'-a%."
829 Pen,e&ena'aan -e'i?inan *ebaaimana %ima(*.% -a%a a,a+ 819 *e2a'a
).n*i0na& +e+a- men=a%i +an.n =a$ab SKPD ,an be'*an(.+an"
Pa*a& 24
(1) 7a(i& B.-a+i menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+
*ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'in+a# +.a*/
)" *.'a+ (e+e'anan me&a(*ana(an +.a*/
" n0+a %ina*/
#" &emba' %i*-0*i*i/
i" +e&aa#an *+a)/
=" &a-0'an/
(" 'e(0men%a*i/ %an
&" mem0"
(2) 7a(i& B.-a+i a+a* nama B.-a+i menan%a+anani na*(a# %ina* me&i-.+i!
a" %a&am ben+.( %an *.*.nan -'0%.( #.(.m (e-.+.*an/
%an
b. %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15
+e'%i'i a+a*!
1" *.'a+ e%a'an/
2" *.'a+ bia*a/
:" *.'a+ (e+e'anan/
4" *.'a+ -e'in+a#/
5" *.'a+ i?in/
4" *.'a+ -e'in+a# +.a*/
7" *.'a+ (e+e'anan me&a(*ana(an +.a*/
6" n0+a %ina*/
1" &emba' %i*-0*i*i/
10" -en.m.man/
11" +e&e'am/
12" be'i+a a2a'a/
1:" -iaam/ %an
14" *e'+i)i(a+"
Pa*a& 25
819 Se('e+a'i* %ae'a# menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan
*.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'=an=ian/
)" *.'a+ -e'in+a# +.a*/
" *.'a+ -e'in+a# -e'=a&anan %ina*/
#" *.'a+ (.a*a/
i" *.'a+ .n%anan/
=" *.'a+ (e+e'anan me&a(*ana(an +.a*/
(" *.'a+ -ani&an/
&" n0+a %ina*/
m" n0+a -ena=.an (0n*e- na*(a# %ina*/
n" &emba' %i*-0*i*i/
0" +e&aa#an *+a)/
-" -en.m.man/
C" &a-0'an/
'" 'e(0men%a*i/
*" *.'a+ -enan+a'/
+" &emba'an %ae'a#/
." be'i+a %ae'a#/
;" be'i+a a2a'a/
$" n0+.&en/
A" mem0/
," %a)+a' #a%i'/ %an
?" *e'+i)i(a+"
829 Se('e+a'i* %ae'a# a+a* nama B.-a+i menan%a+anani na*(a# %ina* ,an
me&i-.+i!
a" %a&am ben+.( %an *.*.nan -'0%.( #.(.m be'.-a (e-.+.*an B.-a+i/ %an
b" %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15
+e'%i'i a+a*!
1" *.'a+ e%a'an/
2" *.'a+ bia*a/
:" *.'a+ (e+e'anan/
4" *.'a+ -e'in+a#/
5" *.'a+ i?in/
4" *.'a+ -e'=an=ian/
7" *.'a+ -e'in+a# +.a*/
6" *.'a+ .n%anan/
1" *.'a+ (e+e'anan me&a(*ana(an +.a*/
10" *.'a+ -ani&an/
11" n0+a %ina*/
12" -en.m.man/
1:" +e&e'am/
14" be'i+a a2a'a/
15" -iaam/
14" *e'+i)i(a+/ %an
17" STTPP"
Pa*a& 24
819 A*i*+en menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+
*ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" n0+a %ina*/
b" n0+a -ena=.an (0n*e- na*(a# %ina*/
2" &emba' %i*-0*i*i/
%" +e&aa#an *+a)/
e" &a-0'an/
)" *.'a+ -enan+a'/
" n0+.&en/ %an
#" mem0"
829 A*i*+en a+a* nama *e('e+a'i* %ae'a# menan%a+anani na*(a# %ina* ben+.( %an
*.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ -e'in+a# +.a*/
e" *.'a+ -e'in+a# -e'=a&anan %ina*/
)" *.'a+ .n%anan/
" *.'a+ -ani&an/
#" n0+a %ina*/
i" n0+a -ena=.an (0n*e- na*(a# %ina*/
=" &a-0'an/
(" *.'a+ -enan+a'/ %an
&" %a)+a' #a%i'"
Pa*a& 27
S+a) a#&i menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+
*ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" n0+a -ena=.an (0n*e- na*(a# %ina*/
b" +e&aa#an *+a)/ %an
2" &a-0'an"
Pa*a& 26
819 Ke-a&a SKPD menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+
*ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'=an=ian/
)" *.'a+ -e'in+a# +.a*/
" *.'a+ -e'in+a# -e'=a&anan %ina*/
#" *.'a+ (.a*a/
i" *.'a+ .n%anan/
=" *.'a+ (e+e'anan me&a(*ana(an +.a*/
(" *.'a+ -ani&an/
&" n0+a %ina*/
m" n0+a -ena=.an (0n*e- na*(a# %ina*/
n" &emba' %i*-0*i*i/
0" +e&aa#an *+a)/
-" -en.m.man/
C" &a-0'an/
'" 'e(0men%a*i/
*" be'i+a a2a'a/
+" mem0/
." %a)+a' #a%i'/ %an
;" *e'+i)i(a+"
829 Ke-a&a SKPD a+a* nama B.-a+i menan%a+anani na*(a# %ina* ,an me&i-.+i!
a" %a&am ben+.( %an *.*.nan -'0%.( #.(.m be'.-a Ke-.+.*an B.-a+i/ %an
b" %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15
+e'%i'i a+a*!
1" *.'a+ bia*a/
2" *.'a+ (e+e'anan/
:" *.'a+ -e'in+a#/
4" *.'a+ .n%anan/ %an
5" *e'+i)i(a+"
8:9 Ke-a&a ba%an -en%i%i(an %an -e&a+i#an *e&a(. (e-a&a SKPD a+a* nama B.-a+i
menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana
%ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ .n%anan/
2" -en.m.man/
%" &a-0'an/
e" +e&e'am/
)" -iaam/
" *e'+i)i(a+/ %an
#" STTPP"
Pa*a& 21
819 Se('e+a'i* DPRD menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan
*.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'=an=ian/
)" *.'a+ -e'in+a# +.a*/
" *.'a+ -e'in+a# -e'=a&anan %ina*/
#" *.'a+ (.a*a/
i" *.'a+ .n%anan/
=" *.'a+ (e+e'anan me&a(*ana(an +.a*/
(" *.'a+ -ani&an/
&" n0+a %ina*/
m" n0+a -ena=.an (0n*e- na*(a# %ina*/
n" &emba' %i*-0*i*i/
0" +e&aa#an *+a)/
-" -en.m.man/
C" &a-0'an/
'" 'e(0men%a*i/
*" be'i+a a2a'a/
+" mem0/ %an
." %a)+a' #a%i'"
829 Se('e+a'i* DPRD a+a* nama B.-a+i menan%a+anani na*(a# %ina* me&i-.+i!
a" %a&am ben+.( %an *.*.nan -'0%.( #.(.m (e-.+.*an B.-a+i, %an
b" %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15
+e'%i'i a+a*!
1" *.'a+ bia*a/
2" *.'a+ (e+e'anan/ %an
:" *.'a+ -e'in+a#"
Pa*a& :0
(1) Ke-a&a UPT %ina*<ba%an menan%a+anani na*(a# %ina* %a&am ben+.( %an
*.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ -e'in+a#/
2" *.'a+ -e'=an=ian/
%" *.'a+ -e'in+a# +.a*/
e" *.'a+ -e'in+a# -e'=a&anan %ina*/
)" *.'a+ (.a*a/
" *.'a+ .n%anan/
#" *.'a+ (e+e'anan me&a(*ana(an +.a*/
i" *.'a+ -ani&an/
=" n0+a %ina*/
(" n0+a -ena=.an (0n*e- na*(a# %ina*/
&" &emba' %i*-0*i*i/
m" +e&aa#an *+a)/
n" -en.m.man/
0" &a-0'an/
-" 'e(0men%a*i/
C" be'i+a a2a'a/
'" mem0/ %an
*" %a)+a' #a%i'"
(2) Ke-a&a UPT %ina*<ba%an a+a* nama (e-a&a %ina*<ba%an menan%a+anani
na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am
Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" n0+a %ina*/ %an
e" %a)+a' #a%i'"
Pa*a& :1
(1) Se('e+a'i* menan%a+anani na*(a# %ina* %a&am ben+.( %an *.*.nan
*.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ (.a*a/
e" *.'a+ .n%anan/
)" n0+a %ina*/
" n0+a -ena=.an (0n*e- na*(a# %ina*/
#" &emba' %i*-0*i*i/
i" +e&aa#an *+a)/
=" &a-0'an/
(" mem0/ %an
&" %a)+a' #a%i'"
(2) Se('e+a'i* a+a* nama (e-a&a SKPD menan%a+anani na*(a# %ina* %a&am
ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" n0+a %ina*/ %an
e" %a)+a' #a%i'"

Pa*a& :2
(1) @ama+ menan%a+anani na*(a# %a&am ben+.( %an *.*.nan
*.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'=an=ian/
)" *.'a+ -e'in+a# +.a*/
" *.'a+ -e'in+a# -e'=a&anan %ina*/
#" *.'a+ (.a*a/
i" *.'a+ .n%anan/
=" *.'a+ (e+e'anan me&a(*ana(an +.a*/
(" *.'a+ -ani&an/
&" n0+a %ina*/
m" n0+a -ena=.an (0n*e- na*(a# %ina*/
n" &emba' %i*-0*i*i/
0" +e&aa#an *+a)/
-" -en.m.man/
C" &a-0'an/
'" 'e(0men%a*i/
*" be'i+a a2a'a/
+" mem0/ %an
." %a)+a' #a%i'"
(2) @ama+ a+a* nama B.-a+i menan%a+anani na*(a# %ina*
%a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i
a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/ %an
%" *.'a+ .n%anan"
Pa*a& ::
819 Ke-a&a baian, (e-a&a bi%an menan%a+anani na*(a# %ina* %a&am ben+.( %an
*.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ -e'in+a#/
b" n0+a %ina*/
2" n0+a -ena=.an (0n*e- na*(a# %ina*/
%" &emba' %i*-0*i*i/
e" +e&aa#an *+a)/
)" &a-0'an/ %an
" %a)+a' #a%i'"
829 Ke-a&a baian, (e-a&a bi%an a+a* nama (e-a&a SKPD menan%a+anani
na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am
-a*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" n0+a %ina*/ %an
e" %a)+a' #a%i'"
Pa*a& :4
819 L.'a# menan%a+anani na*(a# %ina* %a&am ben+.( %an
*.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/
%" *.'a+ i?in/
e" *.'a+ -e'=an=ian/
)" *.'a+ -e'in+a# +.a*/
" *.'a+ -e'in+a# -e'=a&anan %ina*/
#" *.'a+ (.a*a/
i" *.'a+ .n%anan/
=" *.'a+ (e+e'anan me&a(*ana(an +.a*/
(" *.'a+ -ani&an/
&" n0+a %ina*/
m" n0+a -ena=.an (0n*e- na*(a# %ina*/
n" &emba' %i*-0*i*i/
0" +e&aa#an *+a)/
-" -en.m.man/
C" &a-0'an/
'" 'e(0men%a*i/
*" be'i+a a2a'a/
+" mem0/ %an
." %a)+a' #a%i'"
(2) L.'a# a+a* nama 2ama+ menan%a+anani na*(a# %ina*
%a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i
a+a*!
a" *.'a+ bia*a/
b" *.'a+ (e+e'anan/
2" *.'a+ -e'in+a#/ %an
%" *.'a+ .n%anan"
Pa*a& :5
(1) Ke-a&a *.bbaian, (e-a&a *.bbi%an, (e-a&a *e(*i menan%a+anani na*(a#
%ina* %a&am ben+.( %an *.*.nan *.'a+ *ebaaimana %ima(*.% Pa*a& 15 +e'%i'i
a+a*!
a" n0+a %ina*/
b" n0+a -ena=.an (0n*e- na*(a# %ina*/
2" +e&aa#an *+a)/ %an
%" &a-0'an"
(2) Ke-a&a *.bbaian, (e-a&a *.bbi%an, (e-a&a *e(*i, a+a* nama *e('e+a'i*,
(e-a&a baian, (e-a&a bi%an menan%a+anani na*(a# %ina* %a&am ben+.( %an
*.*.nan *.'a+ *ebaaimana %ima(*.% %a&am Pa*a& 15 +e'%i'i a+a*!
a" *.'a+ -e'in+a#/
b" n0+a %ina*/ %an
2" %a)+a' #a%i'"
Baian Keem-a+
Pen%e&ea*ian Penan%a+ananan Na*(a# Dina*
Pa*a& :4
819 Ke+en+.an menenai -en%e&ea*ian -enan%a+ananan na*(a# %ina* %ia+.'
%a&am -e'a+.'an B.-a+i"
829 Pe&a(*anaan -en%e&ea*ian -enan%a+ananan na*(a# %ina* %i+e+a-(an
%enan (e-.+.*an B.-a+i"
Baian Ke&ima
Pen.naan Tin+a .n+.( Na*(a# Dina*
Pa*a& :7
819 Tin+a ,an %i.na(an .n+.( na*(a# %ina* be'$a'na #i+am"
829 Tin+a ,an %i.na(an .n+.( -enan%a+ananan %an -a'a) na*(a# %ina*
be'$a'na bi'. +.a"
8:9 Tin+a ,an %i-e'.na(an .n+.( (e-e'&.an (eamanan na*(a# %ina* be'$a'na
me'a#"
BAB BI
STEMPEL
Baian Ke*a+.
Deni*
Pa*a& :6
Deni* *+em-e& .n+.( na*(a# %ina* %i &in(.nan -eme'in+a# %ae'a# +e'%i'i a+a*!
*+em-e& =aba+an/ %an
*+em-e& -e'an(a+ %ae'a#"
Pa*a& :1
819 S+em-e& =aba+an *ebaaimana %ima(*.% %a&am Pa*a& :6 #.'.) a, *+em-e&
=aba+an B.-a+i"
829 S+em-e& =aba+an B.-a+i *ebaaimana %ima(*.% -a%a a,a+ 819 be'i*i nama
=aba+an %an men.na(an &amban nea'a %enan -emba+a* +an%a bin+an"
Pa*a& 40
S+em-e& -e'an(a+ %ae'a# *ebaaimana %ima(*.% %a&am Pa*a& :6 #.'.) b, +e'%i'i
a+a*!
a" *+em-e& SKPD %an a+a. &embaa &ain/
b" *+em-e& SKPD .n+.( (e-e'&.an +e'+en+./ %an
2" *+em-e& UPT"
Baian Ke%.a
Ben+.(, U(.'an, %an I*i
Pa*a& 41
S+em-e& =aba+an B.-a+i, *+em-e& -e'an(a+ %ae'a# *ebaaimana %ima(*.% %a&am
Pa*a& :6 be'ben+.( &in(a'an"
Pa*a& 42
U(.'an *+em-e& =aba+an, *+em-e& -e'an(a+ %ae'a# *ebaaimana %ima(*.% %a&am
Pa*a& :6 me&i-.+i !
a" .(.'an a'i* +ena# &in(a'an &.a' *+em-e& =aba+an %an
*+em-e& -e'an(a+ %ae'a# a%a&a# 4 2m/
b" .(.'an a'i* +ena# &in(a'an +ena# *+em-e& =aba+an
%an -e'an(a+ %ae'a# a%a&a# :,6 2m/
2" .(.'an a'i* +ena# &in(a'an %a&am *+em-e& =aba+an
%an -e'an(a+ %ae'a# a%a&a# 2,7 2m/ %an
%" =a'a( an+a'a 2 8%.a9 a'i* ,an +e'%a-a+ %a&am &in(a'an
%a&am ma(*ima& 1 2m"
Pa*a& 4:
819 U(.'an *+em-e& SKPD .n+.( (e-e'&.an +e'+en+. *ebaaimana %ima(*.% %a&am
Pa*a& 40 #.'.) b, me&i-.+i !
a" .(.'an a'i* +ena# &in(a'an &.a' *+em-e& =aba+an %an *+em-e& -e'an(a+
%ae'a# a%a&a# 1,6 2m/
b" .(.'an a'i* +ena# &in(a'an +ena# *+em-e& =aba+an %an *+em-e& -e'an(a+
%ae'a# a%a&a# 1,7 2m/
2" .(.'an a'i* +ena# &in(a'an %a&am *+em-e& =aba+an %an *+em-e& -e'an(a+
%ae'a# a%a&a# 1,2 2m/ %an
%" =a'a( an+a'a 2 8%.a9 a'i* ,an +e'%a-a+ %a&am &in(a'an %a&am ma(*ima& 0,5
2m"
829 S+em-e& -e'an(a+ %ae'a# .n+.( (e-e'&.an +e'+en+. *ebaaimana %ima(*.%
-a%a a,a+ 819 %i-e'.na(an .n+.( (a'+. +an%a -en%.%.(, (a'+. -ea$ai, +an%a
-enena&, a*.'an*i (e*e#a+an %an *e=eni*n,a"
Pa*a& 44
819 S+em-e& =aba+an be'i*i nama =aba+an %an men.na(an &amban nea'a
%enan -emba+a* +an%a bin+an"
829 S+em-e& -e'an(a+ %ae'a# *ebaaimana %ima(*.% %a&am -a*a& 40 #.'.) a %an
#.'.) b be'i*i nama Peme'in+a# Kab.-a+en Ban&i, nama SKPD ,an
be'*an(.+an"
8:9 S+em-e& UPT *ebaaimana %ima(*.% %a&am -a*a& 40 #.'.) 2, be'i*i nama
Peme'in+a# Kab.-a+en Ban&i, nama SKPD %an nama UPT ,an
be'*an(.+an"
Baian (e+ia
Pen.naan
Pa*a& 45
819 Pe=aba+ ,an be'#a( men.na(an *+em-e& =aba+an *ebaaimana %ima(*.%
%a&am Pa*a& :6 #.'.) a, B.-a+i %an $a(i& B.-a+i"
829 Pe=aba+ ,an be'#a( men.na(an *+em-e& -e'an(a+ %ae'a# *ebaaimana
%ima(*.% %a&am Pa*a& :6 #.'.) b, (e-a&a SKPD, (e-a&a &embaa &ainn,a,
(e-a&a UPT a+a. -e=aba+ ,an %ibe'i $e$enan"
Pa*a& 44
Pe'an(a+ %ae'a# Kab.-a+en Ban&i ,an be'#a( men.na(an *+em-e& -e'an(a+
%ae'a# *ebaaimana %ima(*.% %a&am Pa*a& :6 #.'.) b me&i-.+i!
a" *e('e+a'ia+ %ae'a#/
b" *e('e+a'ia+ DPRD/
2" %ina* %ae'a#/
%" &embaa +e(ni* %ae'a#/
e" (e2ama+an/
)" (e&.'a#an/ %an
" &embaa &ainn,a"
Pa*a& 47
S+em-e& .n+.( na*(a# %ina* men.na(an +in+a be'$a'na .n. %an %ib.b.#(an
-a%a baian (i'i +an%a+anan -e=aba+ ,an menan%a+anani na*(a# %ina*"
Baian Keem-a+
Ke$enanan Pemean %an Pen,im-an S+em-e&
Pa*a& 46
819 Ke$enanan -emean %an -en,im-an *+em-e& =aba+an .n+.( na*(a# %ina*
%i&a(.(an 0&e# .ni+ ,an membi%ani .'.*an (e+a+a.*a#aan -a%a *e('e+a'ia+
%ae'a#"
829 Ke$enanan -emean %an -en,im-an *+em-e& -e'an(a+ %ae'a# %i&a(.(an
0&e# .ni+ ,an membi%ani .'.*an (e+a+a.*a#aan -a%a *e+ia- SKPD"
8:9 Uni+ ,an membi%ani .'.*an (e+a+a.*a#aan *ebaaimana %ima(*.% -a%a
a,a+ 819 %an a,a+ 829 be'+an.n =a$ab a+a* -en.naan *+em-e&"
849 Pen.n=.(an -e=aba+ -emean %an -en,im-an *+em-e& *ebaaimana
%ima(*.% -a%a a,a+ 8:9 %i+e+a-(an %enan Ke-.+.*an (e-a&a SKPD"
Baian (e&ima
Penamanan
Pa*a& 41
819 Un+.( -enamanan *+em-e& na*(a# %ina* %i &in(.nan Peme'in+a#
Kab.-a+en Ban&i, men.na(an (0%e"
(2) Ke+en+.an &ebi# &an=.+ menenai *+an%a'i*a*i (0%e
-enamanan *+em-e& *ebaaimana %ima(*.% -a%a a,a+ 819 %ia+.' +e'*en%i'i
0&e# B.-a+i"
BAB BII
KOP NASKAH DINAS
Baian Ke*a+.
Deni*
Pa*a& 50
Deni* (0- na*(a# %ina* %i &in(.nan -eme'in+a# %ae'a# +e'%i'i a+a*!
a" (0- na*(a# %ina* =aba+an/ %an
b" (0- na*(a# %ina* -e'an(a+ %ae'a#"
Baian Ke%.a
Ben+.( %an I*i
Pa*a& 51
819 K0- na*(a# %ina* =aba+an *ebaaimana %ima(*.% %a&am Pa*a& 50 #.'.)
a, .n+.( B.-a+i<$a(i& B.-a+i men.na(an!
a" &amban nea'a be'$a'na (.nin ema* %an %i+em-a+(an %ibaian +ena#
a+a* .n+.( na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.( #.(.m/
b" &amban nea'a be'$a'na (.nin ema* %an %i+em-a+(an %ibaian +ena#
a+a* *e'+a a&ama+ n0m0' +e&e-0n, n0m0' )a(*imi&e, $eb *i+e, e3mai& %an
(0%e -0* %i+em-a+(an %ibaian +ena# ba$a# .n+.( na*(a# %ina* %a&am
ben+.( %an *.*.nan *.'a+"
829 K0- na*(a# %ina* -e'an(a+ %ae'a# Kab.-a+en Ban&i mem.a+ *eb.+an
Peme'in+a# Kab.-a+en Ban&i, nama *a+.an (e'=a -e'an(a+ %ae'a#, a&ama+,
n0m0' +e&e-0n, n0m0' )a(*imi&e, $ebi+e, e3mai& %an (0%e -0*"
8:9 K0- na*(a# %ina* (e2ama+an mem.a+ *eb.+an Peme'in+a# Kab.-a+en
Ban&i, nama (e2ama+an, a&ama+, n0m0' +e&e-0n, n0m0' )a(*imi&e, $ebi+e, e3
mai& %an (0%e -0*"
849 K0- na*(a# %ina* (e&.'a#an mem.a+ *eb.+an Peme'in+a# Kab.-a+en
Ban&i, nama (e2ama+an, (e&.'a#an, a&ama+, n0m0' +e&e-0n, n0m0' )a(*imi&e,
$ebi+e, e3mai& %an (0%e -0*"
Baian Ke+ia
Pen.naan
Pa*a& 52
819 K0- na*(a# %ina* *ebaaimana %ima(*.% %a&am Pa*a& 51 a,a+ 819,
%i.na(an .n+.( na*(a# %ina* ,an %i+an%a+anani 0&e# B.-a+i %an $a(i&
B.-a+i"
829 K0- na*(a# %ina* *ebaaimana %ima(*.% %a&am Pa*a& 51 a,a+ 829 %an
a,a+ 8:9, %i.na(an .n+.( na*(a# %ina* ,an %i+an%a+anani 0&e# (e-a&a SKPD
,an be'*an(.+an, &embaa &ainn,a a+a. -e=aba+ &ain ,an %i+.n=.("
8:9 K0- na*(a# %ina* *ebaaimana %ima(*.% %a&am Pa*a& 51 a,a+ 8:9,
%i.na(an .n+.( na*(a# %ina* ,an %i+an%a+anani 0&e# 2ama+ ,an
be'*an(.+an a+a. -e=aba+ &ain ,an %i+.n=.("
849 K0- na*(a# %ina* *ebaaimana %ima(*.% %a&am Pa*a& 51 a,a+ 849,
%i.na(an .n+.( na*(a# %ina* ,an %i+an%a+anani 0&e# &.'a# ,an
be'*an(.+an a+a. -e=aba+ &ain ,an %i+.n=.("
Pa*a& 5:
K0- na*(a# %ina* *ebaaimana %ima(*.% %a&am Pa*a& 51 a,a+ 829 %an a,a+ 8:9
%i.na(an .n+.( na*(a# %ina* ,an %i+an%a+anani 0&e# *+a) a#&i B.-a+i"
BAB BIII
SAMPUL NASKAH DINAS
Baian Ke*a+.
Deni*
Pa*a& 54
Deni* *am-.& na*(a# %ina* %i &in(.nan -eme'in+a# %ae'a# +e'%i'i a+a*!
a" *am-.& na*(a# %ina* =aba+an/ %an
b" *am-.& na*(a# %ina* -e'an(a+ %ae'a#"
Baian Ke%.a
Ben+.(, U(.'an, %an I*i
Pa*a& 55
Sam-.& na*(a# %ina* =aba+an %an *am-.& na*(a# %ina* -e'an(a+ %ae'a#
*ebaaimana %ima(*.% %a&am Pa*a& 54 be'ben+.( em-a+ -e'*ei -an=an"
Pa*a& 54
819 U(.'an *am-.& na*(a# %ina* =aba+an %an *am-.& na*(a# %ina* -e'an(a+
%ae'a# *ebaaimana %ima(*.% %a&am Pa*a& 54 me&i-.+i!
a" *am-.& (an+0n %enan .(.'an -an=an 41 2m %an &eba' :0 2m/
b" *am-.& )0&i0<ma- %enan .(.'an -an=an :5 2m %an &eba' 25 2m/
2" *am-.& *e+ena# )0&i0 %enan .(.'an -an=an 26 2m %an &eba' 16 2m/ %an
%" *am-.& *e-e'em-a+ )0&i0 %enan .(.'an -an=an 26 2m %an &eba' 14 2m"
829 Deni* (e'+a* *am-.& na*(a# %ina* *ebaaimana %ima(*.% -a%a a,a+ 819
men.na(an (e'+a* 2a*in %enan $a'na!
a" -.+i# .n+.( *am-.& na*(a# %ina* =aba+an *ebaaimana %ima(*.% Pa*a& 54
#.'.) a/ %an
b" 20(&a+ .n+.( *am-.& na*(a# %ina* -e'an(a+ %ae'a# *ebaaimana
%ima(*.% Pa*a& 54 #.'.) b"
Pa*a& 57
819 Sam-.& na*(a# %ina* =aba+an be'i*i &amban nea'a be'$a'na (.nin ema*
%an nama =aba+an %an a&ama+, n0m0' +e&e-0n, )a(*imi&e, e3mai&, $eb*i+e %an
(0%e -0* %ibaian +ena# a+a*"
829 Sam-.& -e'an(a+ %ae'a# be'i*i nama -eme'in+a# Kab.-a+en, nama SKPD
,an be'*an(.+an, a&ama+, n0m0' +e&e-0n, )a(*imi&e, e3mai&, $eb*i+e %an (0%e
-0* %ibaian +ena# a+a*"
8:9 Sam-.& UPT be'i*i nama -eme'in+a# Kab.-a+en, nama SKPD %an UPT ,an
be'*an(.+an %an a&ama+, n0m0' +e&e-0n, )a(*imi&e, e3mai&, $eb*i+e %an (0%e
-0* %ibaian +ena# a+a*"
BAB IE
PAPAN NAMA
Baian Ke*a+.
Deni*
Pa*a& 56
Deni* -a-an nama %i &in(.nan -eme'in+a# %ae'a# +e'%i'i a+a*!
a" -a-an nama (an+0' B.-a+i/ %an
b" -a-an nama -e'an(a+ %ae'a#"
Baian Ke%.a
Ben+.(, U(.'an, I*i
Pa*a& 51
Pa-an nama %i &in(.nan -eme'in+a# %ae'a# *ebaaimana %ima(*.% %a&am Pa*a&
56 be'ben+.( em-a+ -e'*ei -an=an"
Pa*a& 40
U(.'an -a-an nama %i &in(.nan -eme'in+a# %ae'a# *ebaaimana %ima(*.%
%a&am Pa*a& 51 %i*e*.ai(an %enan be*a' ban.nan"
Pa*a& 41
819 Pa-an nama %i &in(.nan -eme'in+a# %ae'a# *ebaaimana %ima(*.%
%a&am Pa*a& 56 #.'.) a be'i*i +.&i*an (an+0' B.-a+i, a&ama+, n0m0' +e&e-0n %an
(0%e -0*"
829 Pa-an nama %i &in(.nan -eme'in+a# %ae'a# *ebaaimana %ima(*.%
%a&am Pa*a& 56 #.'.) b be'i*i +.&i*an -eme'in+a# Kab.-a+en %an nama SKPD
,an be'*an(.+an, a&ama+, n0m0' +e&e-0n *e'+a (0%e -0*"
8:9 Deni* ba#an %a*a', $a'na, be*a' #.'.) -a-an nama (an+0' B.-a+i,
-e'an(a+ %ae'a# *ebaaimana %ima(*.% -a%a a,a+ 819 %an a,a+ 829 %ia+.'
0&e# B.-a+i"
Baian Ke+ia
Penem-a+an
Pa*a& 42
Pa-an nama (an+0', -e'an(a+ %ae'a# %i+em-a+(an -a%a +em-a+ ,an *+'a+ei*,
m.%a# %i&i#a+ %an *e'a*i %enan &e+a( %an ben+.( ban.nann,a"
Pa*a& 4:
Bai bebe'a-a (an+0', SKPD ,an be'a%a %i ba$a# *a+. a+a- a+a. *a+. (0m-&e(,
%ib.a+ %a&am *a+. -a-an nama ,an be'+.&i*(an *em.a nama SKPD"
BAB E
PERUBAHAN DAN PEN@ABUTAN
Pa*a& 44
819 Pe'.ba#an %an -en2ab.+an na*(a# %ina* *ebaaimana %ima(*.% %a&am bab ini
%i&a(.(an %enan ben+.( %an *.*.nan na*(a# %ina* ,an *e=eni*"
829 Pe=aba+ ,an menan%a+anani na*(a# %ina* *ebaaimana %ima(*.% -a%a a,a+
819 %i&a(.(an 0&e# -e=aba+ ,an mene+a-(an, mene&.a'(an a+a. -e=aba+
%ia+a*n,a"
BAB EI
PELAPORAN
Pa*a& 45
B.-a+i me&a-0'(an -e&a(*anaan na*(a# %ina* %i &in(.nan Peme'in+a# Kab.-a+en
Ban&i (e-a%a .be'n.'"
BAB EIII
KETENTUAN PENUTUP
Pa*a& 44
Ben+.( %an *.*.nan na*(a# %ina*, -enem-a+an a"n, ."b, ."-, P&+, P&# %an P=, -a'a),
ben+.(, .(.'an %an i*i *+em-e&, (0- na*(a# %ina*, *am-.& na*(a# %ina* %an -a-an
nama *ebaaimana %ima(*.% %a&am bab III, bab IB, bab B, bab BI, bab BII, bab BIII,
%an bab IE +e'2an+.m %a&am &am-i'an Pe'a+.'an B.-a+i ini
Pa*a& 47
Pe'a+.'an B.-a+i ini m.&ai be'&a(. -a%a +ana& %i+e+a-(an"
Aa' *e+ia- 0'an mene+a#.in,a, meme'in+a#(an -en.n%anan Pe'a+.'an B.-a+i
ini %enan -enem-a+ann,a %a&am Be'i+a Dae'a# Kab.-a+en Ban&i"
Di+e+a-(an %i Ban&i
-a%a +ana&
BUPATI BANGLI,
I MADE GIANYAR
Di.n%an(an %i Ban&i
-a%a +ana&
SEKRETARIS DAERAH KABUPATEN BANGLI,
I 7AYAN SUTAPA
BERITA DAERAH KABUPATEN BANGLI TAHUN 2011 NOMOR
LAMPIRAN ! PERATURAN BUPATI BANGLI
NOMOR !
TANGGAL !
BENTUK DAN SUSUNAN NASKAH DINAS, PENEMPATAN a"n, ."b, ."-, P&+, P&#
DAN P=, PARA>, PENANDATANGANAN, BENTUK UKURAN DAN ISI STEMPEL,
KOP NASKAH DINAS, SAMPUL NASKAH DINAS DAN PAPAN NAMA
A. BENTUK DAN SUSUNAN NASKAH DINAS.
BUPATI BANGLI
PERATURAN DAERAH KABUPATEN BANGLI
NOMOR """"""""""""" TAHUN """""""""""
TENTANG
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
DENGAN RAHMAT TUHAN YANG MAHA ESA
BUPATI BANGLI,
Menimban !a" ba#$a """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
b" ba#$a """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" %an *e+e'.*n,a"
Menina+ ! 1" Un%an3Un%an """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/"
2" Pe'a+.'an Peme'in+a# """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
:" %an *e+e'.*n,a"
Denan -e'*e+.=.an be'*ama
DE7AN PER7AKILAN RAKYAT DAERAH KABUPATEN BANGLI
%an
BUPATI BANGLI
MEMUTUSKAN :
Mene+a-(an ! PERATURAN DAERAH TENTANG"""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BAB I
KETENTUAN UMUM
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Pa*a& I
819 FFFFFFFFFFFFFFFFFFFFFFFFFFF/
829 FFFFFFFFFFFFFFFFFFFFFFFFFFF"
BAB II
8%an *e+e'.*n,a9
FFFFFFFFFFFFFFFFFFFF
Pe'a+.'an Dae'a# ini m.&ai be'&a(. -a%a +ana& %i.n%an(an"
Aa' *e+ia- 0'an mene+a#.in,a, meme'in+a#(an -en.n%anan
%enan -enem-a+ann,a %a&am Lemba'an Dae'a# Kab.-a+en
Ban&i"
Di+e+a-(an %i FFFFFFF"
-a%a +ana& FFFFFFF"
BUPATI BANGLI

NAMA
Di.n%an(an %i FFF""
-a%a +ana& FFF"F"
SEKRETARIS DAERAH KABUPATEN BANGLI,
NAMA
Pan(a+
NIP"
LEMBARAN DAERAH KABUPATEN BANGLI TAHUN """" NOMOR """""
BUPATI BANGLI
PERATURAN BUPATI BANGLI
NOMORFF" TAHUNFFF"
TENTANG
FFFFFFFFFFFFFFFFFFFFFFFFF
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
DENGAN RAHMAT TUHAN YANG MAHA ESA
BUPATI BANGLI,
Menimban ! a" ba#$a FFFFFFFFFFFFFFFFFFFFFFFFF"
FFFFFFFFFFFFFFFFFFFFFFFFFFF"/
b" ba#$a """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" %an *e+e'.*n,a/
Menina+ ! 1" Un%an3Un%an """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" Pe'a+.'an Peme'in+a# """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
:" %an *e+e'.*n,a/
MEMUTUSKAN !
Mene+a-(an ! " PERATURAN BUPATI TENTANG""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BAB I
KETENTUAN UMUM
""""""""""""""""""""""""""""""""""""
Pa*a& I
FFFFFFFFFFFFFFFFFFFFFFFFFFFF"" !
819 FFFFFFFFFFFFFFFFFFFFFFFFFFF"/
829 F"""FFFFFFFFFFFFFFFFFFFFFFFFF""/
8:9 %an *e+e'.*n,a"
BAB II
8%an *e+e'.*n,a9
FFFFFFFFFFFFFFFFFFF""
Pe'a+.'an B.-a+i ini m.&ai be'&a(. -a%a +ana& %i.n%an(an"
Aa' *e+ia- 0'an mene+a#.in,a, meme'in+a#(an -en.n%anan
%enan -enem-a+ann,a %a&am Be'i+a Dae'a# Kab.-a+en Ban&i"

Di+e+a-(an %i FFFFFF
-a%a +ana& FFFFFF
BUPATI BANGLI,
NAMA
Di.n%an(an %i FFF"
-a%a +ana& FFFF"
SEKRETARIS DAERAH KABUPATEN BANGLI,
NAMA
Pan(a+
NIP"
BERITA DAERAH KABUPATEN BANGLI TAHUN """ NOMOR
BUPATI FFFFFFFFFF"
PERATURAN BERSAMA BUPATI BANGLI
DAN BUPATI<7ALIKOTAFFFFFFFF""
NOMOR FFF" TAHUN FFFF
NOMOR FFF" TAHUN FFFF
TENTANG
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM
MMMMMMMMMMMMMMMMMMMMMMMMMMMMMMM
DENGAN RAHMAT TUHAN YANG MAHA ESA
BUPATI BANGLI DAN FFFFFFFFFFF""
Menimban a" ba#$a """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"" /
b" ba#$a """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" %an *e+e'.*n,a/
Menina+ ! 1" Un%an3Un%an """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" Pe'a+.'an Peme'in+a# """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
:" %an *e+e'.*n,a/
MEMUTUSKAN !
Mene+a-(an ! PERATURAN BERSAMA BUPATI BANGLI
DAN BUPATI<7ALIKOTA"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BAB I
KETENTUAN UMUM
""""""""""""""""""""""""""""""""""""""""""""""""
Pa*a& 1
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
819 FFFFFFFFFFFFFFFFFFFFFFFFFFFF"/
829 FFFFFFFFFFFFFFFFFFFFFFFFFFFF"/
8:9 %an *e+e'.*n,a"
Pa*a&
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFF""
FFFFFFFFFFFFFFFFFFFFFFFFFFFFF
FF

BAB II
8%an *e+e'.*n,a9
FFFFFFFFFFFFF"
Pe'a+.'an Be'*ama B.-a+i Ban&i %an B.-a+i<7a&i(0+a F""ini m.&ai
be'&a(. -a%a +ana& %i.n%an(an" Aa' *e+ia- 0'an
mene+a#.in,a, meme'in+a#(an -en.n%anan %enan
-enem-a+ann,a %a&am 8Lembaran Daerah/Berita Daerah)

Di+e+a-(an %i FFFFFFF
-a%a +ana& """"""""""""FFFF
BUPATI FFF BUPATI FFFF
NAMA NAMA
Di.n%an(an %i FFF"
-a%a +ana& FFFF"
SEKRETARIS DAERAH 8Pem'a(a'*a9
NAMA
Pan(a+
NIP"
BERITA DAERAH KABUPATEN8Pem'a(a'*a9""""""FF"
TAHUN FFF"" NOMOR FFFFFF
BUPATI BANGLI
KEPUTUSAN BUPATI BANGLI
NOMORFF" TAHUNFFF"
TENTANG
FFFFFFFFFFFFFFFFFFFF
FFFFFFFFFFFFFFFFFFFF
BUPATI BANGLI,
Menimban ! a" ba#$a FFFFFFFFFFFFFFFFFFFFFFFFF"
FFFFFFFFFFF""""""""FFFFFFFFFFFFFFF"/
b" ba#$a FFFFFFFFFFFFFFFFFFFFFFFFF"
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" %an *e+e'.*n,a/
Menina+ ! 1" Un%an3Un%an FFFFFFFFFFFFFFFFFFFFF""
FFFFFFFFFFFFFFFFFFFFFFFFFFFFF/
2" Pe'a+.'an Peme'in+a# FFFFFFFFFFFFFFFFFFF"
FFFFFFFFFFFFFFFFFFFFFFFFFFFFF"
:" %an *e+e'.*n,a/
MEMUTUSKAN !
Mene+a-(an ! KEPUTUSAN BUPATI TENTANG""""""""""""""""""""""""""""""""
KESATU ! FFFFFFFFFFFFFFFFFFFFFFFFFFFFF/
K E D U A ! FFFFFFFFFFFFFFFFFFFFFFFFFFFFF/
KETIGA ! FFFFFFFFFFFFFFFFFFFFFFFFFFFFF/
KEEMPAT ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFF
-a%a +ana& FFFFFF
BUPATI BANGLI,
Sa&inan *e*.ai %enan a*&in,a
KEPALA BAGIAN HUKUM DAN HAM,
NAMA NAMA
PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DAERAH
Jl. Brigjen Ngurah Rai No !. BangliTel"on. #!$$%.... &a' #!$$% .......
(((. ......... e)ail* ..................
KEPUTUSAN BUPATI BANGLI
NOMORFF" TAHUNFFF"
TENTANG
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BUPATI BANGLI,
Menimban ! a" ba#$a """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
b" ba#$a """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" %an *e+e'.*n,a/
Menina+ ! 1" Un%an3Un%an """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
2" Pe'a+.'an Peme'in+a# """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
:" %an *e+e'.*n,a/
MEMUTUSKAN !
Mene+a-(an ! KEPUTUSAN BUPATI TENTANG"""""""""""""""""""""""""""""""
KESATU ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
K E D U A ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
KETIGA ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""/
KEEMPAT ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFF
-a%a +ana& FFFFFF
a"n" BUPATI BANGLI
SEKRETARIS DAERAH,
Sa&inan *e*.ai %enan a*&in,a
KEPALA BAGIAN HUKUM DAN HAM
NAMA NAMA
BUPATI BANGLI
INSTRUKSI BUPATI BANGLI
NOMOR FFF" FFFF
TENTANG
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BUPATI BANGLI,
Da&am 'an(a F"""FFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""
%enan ini menin*+'.(*i(an!
Ke-a%a ! 1" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
:" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
4" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( !
KESATU ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
KEDUA ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
KETIGA ! %an *e+e'.*n,a/
In*+'.(*i ini m.&ai be'&a(. -a%a +ana& %i+e+a-(an
Di+e+a-(an %i FFFFF"
-a%a +ana& FFFFF"
BUPATI BANGLI,
NAMA
BUPATI BANGLI
Tem-a+, Tana&, B.&an %an
Ta#.n
Ke-a%a
Y+#" """""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""
%i 3
"""""""""""""""""""""""""
SURAT EDARAN
NOMORFFFFFFF" FFFFFF"
TENTANG
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BUPATI BANGLI,
NAMA

BUPATI BANGLI
Tem-a+, Tana&, B.&an %an Ta#.n
Ke-a%a
N0m0' ! Y+#" FFFFFFFFFFFF"
Si)a+ ! FFFFFFFFFFFF"
Lam-i'an !
Ha& ! FFFFFFFFFF" %i 3
FFFFFFFFFF"
FFFFFFF""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
BUPATI BANGLI,
NAMA

Da&an" FFFFF" N0m0'" F"""""""", P'0;in*i """"""""""""""""""""""""
Te&-" 80009 EEEEEEE 8E3mai&9"""""""""", 7eb*i+e $$$...............................
BUPATI BANGLI
SURAT KETERANGAN
NOMOR FFFFFFFF""
Yan be'+an%a+anan %iba$a# ini !
a" Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
b" Daba+an ! B.-a+i Ban&i
%enan ini mene'an(an ba#$a !
a" Nama<NIP ! """"""""""""""""""""""""""""""""""<NIP""""""""""""""""""""""
b" Pan(a+<G0&0nan ! """""""""""""""""""""""""""""""<"""""""""""""""""""""""""""""""
2" Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ma(*.% ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Demi(ian S.'a+ Ke+e'anan ini %ib.a+ .n+.( %i-e'.na(an *e-e'&.n,a"
Tem-a+, Tana&, B.&an %an Ta#.n
BUPATI BANGLI,
NAMA
BUPATI BANGLI
SURAT PERINTAH
NOMOR" FFFFFFFFFF"
Nama 8,an membe'i(an -e'in+a#9 ! """"""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""
MEMERINTAHKAN !
Ke-a%a !
a" Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""
b" Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( !
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFFF""
-a%a +ana& FFFFFFF""
BUPATI BANGLI,

NAMA
BUPATI BANGLI
SURAT IGIN BUPATI BANGLI
NOMOR FFFFFFFFF
TENTANG
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Da*a' ! a" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
b" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
MEMBERI IGIN!
Ke-a%a !
Nama ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
A&ama+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFFFFF
-a%a +ana& FFFFFFFFF
BUPATI BANGLI,
NAMA
BUPATI BANGLI
SURAT PERJANJIAN
NOMOR FFF"<FFF"<FFF<FF""
TENTANG
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Pa%a #a'i """""""""""""", Tana& """""""""""""""", B.&an """""""""""""""""""" %an Ta#.n """""""""""""""",
be'+em-a+ %i """"""""""""""""""""", (ami ,an be'+an%a +anan %iba$a# ini!
1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" PIHAK KE I
2" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" PIHAK KE II
Pa*a& """"
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" 8i*i -e'=an=ian9
Pa*a& """""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Pen.+.-
S.'a+ -e'=an=ian ini %i+an%a+anani 0&e# (e%.a be&a# -i#a(, -a%a #a'i %an +ana&
+e'*eb.+ %ia+a*"
PIHAK KE II PIHAK KE I
BUPATI BANGLI,
NAMA DELAS NAMA DELAS
Pan(a+
NIP
Sa(*i3*a(*i!
1" """"""""""""""""""""""""""" 8+an%a+anan9
2" """"""""""""""""""""""""""""8+an%a+anan9
:" %*+"""""""""""""""""""""""
METERAI
NOTA KESEPAKATAN
ANTARA
PEMERINTAH FFFFFFFFFF"
REPUBLIK INDONESIA
DAN
PEMERINTAH FFFFFFFFFF"
REPUBLIK FFFFF""
Peme'in+a# FFFFFF", Re-.b&i( In%0ne*ia %an Peme'in+a#
FFFFFFF, Re-.b&i( FFFFFFFFFFFF, ,an %a&am #a& ini %i*eb.+
*ebaai HPa'a Pi#a(I"
Ber+einginan .n+.( menin(a+(an #.b.nan bai( %an (e'=a*ama an+a'a
ma*,a'a(a+ (e%.a be&a# -i#a( !
Menga+ui -en+inn,a -'in*i- (e*e+a'aan %an *a&in men.n+.n(an
Meruju+ (e-a%a N0+a Ke*e-a#aman an+a'a Peme'in+a# "FFFFF",
Re-.b&i( In%0ne*ia %an Peme'in+a#, Re-.b&i( """"""""""""""""", %a&am .-a,a .n+.(
menin(a+(an (e'=a*ama, ,an %i+an%anani %i Kab.-a+en FFF"", +&F""b&nF"
+a#.n"
Se,uai -engan #.(.m, -e'a+.'an %an -'0*e%.' a%mini*+'a+i) ,an be'&a(.
-a%a Nea'a ma*in3ma*in
Telah )en.a"ai +e,e"a+a/an *ebaai be'i(.+!
ARTIKEL 1
TUDUAN DAN RUANG LINGKUP KERDASAMA
Pa'a -i#a( a(an memben+.( *eb.a# (e'=a*ama Kab.-a+en """""""""""""""" .n+.(
menin(a+(an %an mem-e'&.a* (e'=a*ama ,an e)e(+i) %an *a&in men.n+.n(an
bai -enembanan (e%.a Kab.-a+en, %a&am ba+a* (emam-.an (e.anan %an
+e(ni* ,an %imi&i(i, -a%a bi%an3bi%an *ebaai be'i(.+ !
1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
ARTIKEL 2
PEMBIAYAAN
Sea&a (eia+an ,an mena2. (e-a%a N0+a (e*e-a(a+an ini be'an+.n (e-a%a
(e+e'*e%iaan %ana %an -e'*0na& Pa'a Pi#a(, *e'+a *.mbe' &ain ,an +e'*e%ia, ,an
%i*e-a(a+i 0&e# Pa'a Pi#a("
ARTIKEL :
PENGATURAN TEKNIS
Un+.( mem)a*i&i+a*i -e&a(*anaan %a'i N0+a (e*e-a(a+an ini, Pa'a Pi#a( %a-a+
memb.a+ -ena+.'an -'0'am, -'0,e( a+a. 'en2ana +in%a( ,an +e'2a(.- %a&am
(e*e&.'.#an %a'i N0+a Ke*e-a(a+an ini, ,an me&i-.+i bi%an3bi%an *ebaaimana
+e'*eb.+ %i%a&am A'+i(e& 1"
ARTIKEL 4
KELOMPOK KERDA
1" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
ARTIKEL 5
PENYELESAIAN PERSELISIHAN
Se+ia- -e'*e&i*i#an ,an +imb.& %a&am -ena)*i'an a+a. -e&a(*anaan N0+a
(e*e-a(a+an ini, a(an %i*e&e*ai(an *e2a'a %amai me&a&.i (0n*.&+a*i ne0*ia*i
an+a'a Pa'a Pi#a("
ARTIKEL 4
PERUBAHAN
N0+a (e*e-a(a+an ini %a-a+ %i.ba# a+a. %i-e'bai(i" Ma*in3ma*in -i#a( %a-a+
memin+a -e'bai(an a+a. -e'.ba#an" Sea&a ben+.( -e'.ba#an a+a.-.n
-e'bai(an ,an %i*e-a(a+i (e%.a be&a# -i#a( #a'.* me'.-a(an baian in+e'a&
%a'i N0+a Ke*e-a(a+an ini" Pe'bai(an a+a. -e'.ba#an +e'*eb.+ %ibe'&a(.(an
-a%a +ana& ,an +e&a# %i+en+.(an 0&e# Pa'a Pi#a("
ARTIKEL 7
PEMBERLAKUAN, MASA BERLAKU DAN PENGAKHIRAN
1" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
:" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
DENGAN DISAKSIKAN 0LEH, -i#a(3-i#a( ba$a# ini, *ebaaimana +e&a#
%i*a#(an 0&e# Peme'in+a# Dae'a# ma*in3ma*in, +e&a# menan%a+anani N0+a
Ke*e-a(a+an ini"
GUBERNUR<BUPATI<"""""""""""""""""""""""""""""""""""""" GUBERNUR<BUPATI""""""""""""""
REPUBLIK INDONESIA REPUBLIK """"""""""""""""""""""""""""""""""
NAMA NAMA
10NT0H
&0RMAT MAP

Jl. 22222 No. 2 Bangli Ko-e Po, 222
Tel"on. #!$$% 2222. &a' #!$$% 222.
(((.* 22.
PEMERINTAH KABUPATEN BAN!I
BUPATI BANGLI
SURAT PERINTAH TUGAS
NOMOR FFFFFFF
Da*a' ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

MEMERINTAHKAN !
Ke-a%a ! 1" Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
Pan(a+<0& ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
NIP ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
2" Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
Pan(a+<0& ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
NIP ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( ! 1" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
:" """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFFF""
-a%a +ana& FFFFFFFF""
BUPATI BANGLI,
NAMA

PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DAERAH
Jl. Brigjen Ngurah Rai No !. BangliTel"on. #!$$% ...... &a' #!$$% 22
(((. .................................... e)ail* ............................................
Lemba' (e ! FFFFFFF""
K0%e N0 ! """""""""""""""""""""""""""
N0m0' ! """""""""""""""""""""""""""
SURAT PERINTAH PERDALANAN DINAS
8 S P P D 9
1" Pe=aba+ ,an membe'i -e'in+a# Se('e+a'i* Dae'a#
2" Nama Pea$ai ,an %i-e'in+a#
:" a" Pan(a+ %an G0&0nan men.'.+
PP N0" 4 Ta#.n 1117
b" Daba+an
2" Tin(a+ men.'.+ -e'a+.'an
-e'=a&anan
4" Ma(*.% Pe'=a&anan Dina*
5" A&a+ an(.+ ,an %i.na(an
4" a" Tem-a+ be'an(a+
b" Tem-a+ +.=.an
7" a" Laman,a Pe'=a&anan Dina*
b" Tana& be'an(a+
2" Tana& #a'.* (emba&i
6" Peni(.+
1" Pembebanan Ana'an
a" In*+an*i
b" Ma+a Ana'an
10" Ke+e'anan &ain3&ain
Di(e&.a'(an %i ! FFFFFFFF
-a%a +ana& !

SEKRETARIS DAERAH,
NAMA PEDABAT

SPPD No. * ..............................
Berang+a/ -ari
#/e)"a/ +e-u-u+an% * ..............................
Pa-a /anggal * ..............................
Ke * ..............................

Sela+u "ela+,ana /e+ni, +egia/an
II. Ti3a -i * ................................. Berang+a/ -ari *...........................
Pa-a /anggal * .................................. Ke * 222...............
Ke"ala Pa-a /anggal * ..........................
Ke"ala
III. Ti3a -i * ................................ Berang+a/ -ari *...........................
Pa-a /anggal * .................................. Ke * 222...............
Ke"ala Pa-a /anggal * ..........................
Ke"ala
I4. Ti3a -i * ................................ Berang+a/ -ari *...........................
Pa-a /anggal * .................................. Ke * 222...............
Ke"ala Pa-a /anggal * ..........................
Ke"ala
4. Ti3a +e)3ali -i *
Pa-a /anggal * ..............................................
Telah -i"eri+,a, -engan +e/erangan 3ah(a
"erjalanan /er,e3u/ -ia/a, 3enar -ila+u+an a/a,
"erin/ahn5a -an ,e)a/a6)a/a un/u+
+e"en/ingan ja3a/an -ala) (a+/u 5ang
,e,ing+a/6,ing+a/n5a.
SEKRETARIS DAERAH
NAMA PEJABAT
4I. 1ATATAN LAIN6LAIN
4II. PERHATIAN
Peja3a/ 5ang 3er(enang )ener3i/+an SPPD, "ega(ai 5ang )ela+u+an
"erjalanan -ina,, "ara "eja3a/ 5ang )enge,ah+an /anggal 3erang+a/7/i3a
,er/a Ben-ahara(an 3er/anggung ja(a3 3er-a,ar+an "era/uran6"era/uran
Keuangan Negara a"a3ila Negara )en-a"a/ rugi a+i3a/ +e,alahan,
+eal"aann5a.
BUPATI BANGLI
SURAT KUASA
N0m0' " " " " " " " " " " " " " "
Yan be'+an%a+anan %iba$a# ini !
a" Nama ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""
b" Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""
MEMBERI KUASA
Ke-a%a !
a" Nama ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""
b" Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""
2" NIP" ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( !
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Demi(ian S.'a+ K.a*a ini %ib.a+ .n+.( %a-a+ %i-e'.na(an *ebaaimana
me*+in,a"
Tem-a+, Tana&, B.&an %an Ta#.n
Yan %ibe'i (.a*a Yan membe'i (.a*a
NAMA DABATAN BUPATI BANGLI,
NAMA NAMA
Pan(a+
NIP"
BUPATI BANGLI
Tem-a+, Tana&, B.&an %an Ta#.n
Ke-a%a
N0m0' ! """"""""""""""""""""""" Y+#" """"""""""""""""""""""""""""""""""""""""""""
Si)a+ ! """"""""""""""""""""""" """""""""""""""""""""""""""""""""""""""""""
Lam-i'an ! """""""""""""""""""""""
Ha& ! Un%anan %i 3
""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ha'i ! """"""""""""""""""""""""""""""""""""""""""""""""
Tana& ! """"""""""""""""""""""""""""""""""""""""""""""""
P.(.& ! """"""""""""""""""""""""""""""""""""""""""""""""
Tem-a+ ! """"""""""""""""""""""""""""""""""""""""""""""""
A2a'a ! """"""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

BUPATIFFF"",
NAMA
@a+a+an !
1" """""""""""""""""""""""""""""""""""""""""""""""""
2" """""""""""""""""""""""""""""""""""""""""""""""""
BUPATI BANGLI
SURAT KETERANGAN MELAKSANAKAN TUGAS
NOMOR FFFFFFFFFF
Yan be'+an%a +anan %iba$a# ini !
Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""
NIP ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Pan(a+<G0&0nan ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Denan ini mene'an(an %enan *e*.n.#n,a ba#$a !
Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""
NIP ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Pan(a+<G0&0nan ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """"""""""""""""""""""""""""""""""""""""""""""""""""
Yan %ian(a+ be'%a*a'(an Pe'a+.'an """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""" N0m0' """"""""""""""""""""""""" +e'#i+.n """"""""""""""""""""""""""""""""""""""""""""""""""""""""""
+e&a# n,a+a men=a&an(an +.a* *ebaai"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
%i 3
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Demi(ian *.'a+ (e+e'anan me&a(*ana(an +.a* ini *a,a b.a+ %enan
*e*.n.#n,a %enan menina+ *.m-a# =aba+an<-ea$ai nee'i *i-i& %an
a-abi&a %i(em.%ian #a'i i*i *.'a+ -e'n,a+aan ini +e'n,a+a +i%a( bena' ,an
be'a(iba+ (e'.ian bai nea'a, ma(a *a,a be'*e%ia menan.n (e'.ian
+e'*eb.+"
Tem-a+, Tana&, B.&an %an Ta#.n
BUPATI BANGLI,
NAMA
BUPATI BANGLI
Tem-a+, Tana&, B.&an %an Ta#.n
Ke-a%a
N0m0' ! """""""""""""""""""""""""""" Y+#""""""""""""""""""""""""""""""""""""""""""""""""""""""
Si)a+ ! """""""""""""""""""""""""""" """""""""""""""""""""""""""""""""""""""""""""""""""""
Lam-i'an ! """"""""""""""""""""""""""""
Ha& ! Pani&an" %i 3
""""""""""""""""""""""""""""""""""""""""
Denan ini %imin+a (e%a+anan Sa.%a'a %i Kan+0' """""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""", -a%a!
Ha'i ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tana& ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
P.(.& ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Men#a%a-
(e-a%a ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
J A&ama+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

Demi(ian .n+.( %i&a(*ana(an %an men=a%i -e'#a+ian
*e-en.#n,a"
BUPATIFF"",
NAMA
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* ............................................
NOTA K DINAS
Ke-a%a ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Da'i ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tana& ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
N0m0' ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Si)a+ ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Lam-i'an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ha& ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
KEPALA BADAN < DINAS"""""""""""""""""",
NAMA PEDABAT
Pan(a+
NIP"
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* ............................................
Tem-a+, Tana&, B.&an %an Ta#.n
Ke-a%a
N0m0' ! """""""""""""""""""""""""""""""
Y+#" """"""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""
%i 3
"""""""""""""""""""""""""""""
NOTA PENGADUAN KONSEP NASKAH DINAS
Di*am-ai(an %enan #0'ma+ !""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ten+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""
@a+a+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""
Lam-i'an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""
Un+.( M0#0n -e'*e+.=.an %an
+an%a +anan a+a* ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""

DISPOSISI PIMPINAN KEPALA BADAN <
DINASFF"",
Tin%a( &an=.+ *+a) NAMA PEDABAT
Pan(a+
NIP
@a+a+an ! @0'e+ ,an +i%a( -e'&."
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* ............................................
L E M B A R D I S P 0 S I S I
S.'a+ %a'i !
N0" S.'a+ !
T&" S.'a+ !
Di+e'ima T& !
N0" Aen%a !
Si)a+ !
Sana+ *ee'a See'a Ra#a*ia
Pe'i#a& !
Di+e'.*(an (e-a%a S%'"!

"""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""
Dan *e+e'.*n,an,a FFF"
Denan #0'ma+ #a'a-!
Tana-an %an Sa'an
P'0*e* &ebi# &an=.+
K00'%ina*i<(0n)i'ma*i(an
FFFFFFFFFFF
FFFFFFFFFFF
@a+a+an !
Nama Daba+an
Pa'a) %an +ana&
Nama Pe=aba+


PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* ............................................
TELAAHAN STA>
Ke-a%a ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Da'i ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tana& ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""
N0m0' ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Lam-i'an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ha& ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
I" Pe'*0a&an"

II" P'aana-an
III" >a(+a3>a(+a ,an mem-ena'.#i
IB" Ana&i*i*
B" Ke*im-.&an
BI" Sa'an
NAMA DABATAN
NAMA PEDABAT
Pan(a+
NIP
BUPATI BANGLI
PENGUMUMAN
NOMOR ! FFFFF
TENTANG
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Di+e+a-(an %i FFFFFFFF"
-a%a +ana&FFFFFFFFF
BUPATI BANGLI,
NAMA

PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* ............................................
LAPORAN
TENTANG
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
I" Pen%a#.&.an"
A" Um.m<&a+a' be&a(an
B" Lan%a*an H.(.m
@" Ma(*.% %an T.=.an
II" Keia+an ,an %i&a(*ana(an,
III" Ha*i& ,an %i2a-ai,
IB" Ke*im-.&an %an Sa'an
B" Pen.+.-"
Dib.a+ %i
-a%a +ana&

Nama Daba+an


NAMA PEDABAT
Pan(a+
NIP"

BUPATI BANGLI
REKOMENDASI """""""""""""""""""""""""""""""
NOMOR FFFFF
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
a. FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF
F
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF

b" FFFFFFFFFFFFFFFFFFFFFFFFFFFF
FFFF
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF

"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+, Tana&, B.&an %an Ta#.n
BUPATI BANGLI,
NAMA
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((..................................... e)ail* .............................................
Tem-a+, Tana&, B.&an %an Ta#.n"
Ke-a%a,
Y+# """""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""
%i K
"""""""""""""""""""""""""""""""""
SURAT PENGANTAR
NOMOR ! FFFFF
N0" Deni* ,an %i(i'im Ban,a(n,a Ke+e'anan
Di+e'ima +ana& FFFFF"
Pene'ima Peni'im
Nama Daba+an, Nama Daba+an,
Nama -e=aba+ Nama -e=aba+
Pan(a+ Pan(a+
NIP" NIP"
N0m0' +e&e-0n " " " " " " " " " "
>ORMULIR BERITA
Rei*+'a*i N0 ! FFFFFF
PANGGILAN DENIS NOMOR DERADAT
DARI ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
UNTUK ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
TEMBUSAN ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
KLASI>IKASI ! SEGERA
N0m0' ! FFFFFFFFF
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""KMA """"""""
"
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""" TTK
AAA TTK """"""""""""""""""""""""""""""""""""""""""""""""""""""" KMA""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" TTK
BBB TTK """""""""""""""""""""""""""""""""""""""""""""""""""""""KMA"""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" TTK

@@@ TTK DAN SETERUSNYANYA TTK HBS
Tana& $a(+. -emb.a+an FFFFF"
7a(+.
Peni'im !
Nama !
Daba+an !
Tan%a +anan !
N0"K0%e La&.
Lin+a*
Pa'a)
O-e'a+0'
Te'ima Ki'im
LEMBARAN DAERAH KABUPATEN BANGLI
N0m0' FF Ta#.n FF"" Se'i F" N0m0' FFF""
PERATURAN DAERAH KABUPATEN BANGLI
N0m0' ! FFF""
TENTANG
FFFFFFFFFFFFFFFFFFFFFFF
FFFFFFFFFFFFFFFFFFFFFFF%an *e+e'.*n,a
Di.n%an(an %a&am &emba'an %ae'a# Kab.-a+en Ban&i
N0m0' FF" Ta#.n FF""
Se'i FF"
Tana& FFFF"
SEKRETARIS DAERAH KABUPATEN
BANGLI,
NAMA PEDABAT
Pan(a+
NIP"
BERITA DAERAH KABUPATEN BANGLI
N0m0' FF Ta#.n FF"" Se'i F" N0m0' FFF""
PERATURAN KEPALA DAERAH FFF"<KEPUTUSAN KEPALA DAERAH FF
N0m0' ! FFF""
TENTANG
FFFFFFFFFFFFFFFFFFFFFFF
FFFFFFFFFFFFFFFFFFFFFFF%an *e+e'.*n,a
Di.n%an(an %a&am &emba'an %ae'a# Kab.-a+en Ban&i
N0m0' FF" Ta#.n FF""
Se'i FF"
Tana& FFFF"
SEKRETARIS DAERAH KABUPATEN
BANGLI,
NAMA PEDABAT
Pan(a+
NIP"
BUPATI BANGLI
BERITA A@ARA
LLLLLLLLLLLLLLL
NOMOR ! FFF
Pa%a #a'i ini +ana&""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" (ami ma*in3ma*in!
1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ,an *e&an=.+n,a
%i*eb.+ Pi#a( Pe'+ama 8mem.a+ nama, NIP, Pan(a+<G0&0nan, Daba+an %an
a&ama+9
2" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" ,an *e&an=.+n,a
%i*eb.+ Pi#a( Ke%.a
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

Be'i+a A2a'a ini %ib.a+ %enan *e*.n.#n,a %a&am 'an(a-F"" .n+.(
%i-e'.na(an *ebaaimana me*+in,a"
Dib.a+ %i """""""""""""""""""""""""""""""""""
Pi#a( Ke%.a Pi#a( Pe'+ama
BUPATI BANGLI,
NAMA PEDABAT NAMA
Pan(a+
NIP"
Mene+a#.i<Mene*a#(an

NAMA PEDABAT
Pan(a+
NIP"
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* .............................................
NOTULEN
Si%an<Ra-a+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ha'i<Tana& ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
7a(+. Pani&an ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
7a(+. *i%an<'a-a+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
A2a'a ! 1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" %an *e+e'.*n,a
:" Pen.+.-"
Pim-inan Si%an<Ra-a+
Ke+.a ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Se('e+a'i* ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Pen2a+a+ ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Pe*e'+a *i%an<'a-a+ ! 1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" %an *e+e'.*n,a"
Keia+an Si%an<Ra-a+ ! 1" """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
2" %an *e+e'.*n,a"
1" Ka+a Pemb.(aan ! FFFFFFFFFFFFFFFFFFFFF""
2" Pemba#a*an ! FFFFFFFFFFFFFFFFFFFFF"""
:" Pe'a+.'an ! FFFFFFFFFFFFFFFFFFFFFF
FFFFFFFFFFFFFFFFFFFFF"
PIMPINAN SIDANG<RAPAT
NAMA DABATAN
NAMA PEDABAT
Pan(a+
NIP"
BUPATI BANGLI
M E M O
Da'i ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Ke-a%a ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
LLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLLL
I S I !
"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""" """"
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
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""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""

Tem-a+, Tana&, B.&an %an Ta#.n
BUPATI BANGLI,
Tan%a Tanan a+a. Pa'a)
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* .............................................
DA>TAR HADIR PERTEMUAN RAPAT
Ha'i ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tana&
! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
7a(+. ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+
! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
A2a'a ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
NO" NAMA DABATAN<
PANGKAT
TANDA
TANGAN
KET
1"
2"
:"
%an
*e+e'.*n,a"
Tem-a+, Tana&, B.&an %an Ta#.n
NAMA DABATAN
NAMA PEDABAT
Pan(a+
NIP"
PEMERINTAH KABUPATEN BANGLI
BADAN 7 DINAS2222222.
Jl. 222 No. 2. Bangli Tel"on. #!$$% 2.&a' #!$$% 2.
(((. .................................... e)ail* .............................................
DA>TAR HADIR
BULAN !
MINGGU !
N
O"
NAMA PANGKAT<
GOL
TANGGAL KET
P S P S P S P S
1 2 : 4 5 4 7 6 1 10 11 12
KEPALA SUB
BAGIAN<
SEKRETARIS
Tem-a+, Tana&, B.&an %an Ta#.n
NAMA DABATAN
NAMA PEDABAT
Pan(a+
NIP"




































6
9
P

BUPATI BANGLI
PIAGAM PENGHARGAAN
N0m0' !
BUPATI FFFFFFFF" Denan ini membe'i(an -en#a'aan (e-a%a !
Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+<Tana& &a#i' ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
NIP<NRP ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Daba+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
In*+an*i ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+, Tana&, B.&an %an Ta#.n

BUPATI BANGLI
NAMA DELAS




































6
9



































7
1
BUPATI BANGLI
S E R T I F I K A T
Diberikan kepada :
Nama :
NIP :
Instansi :

Sebagai/Atas partisipasinya dalam ………………….……….
………………… yang diselenggarakan oleh …………………………………
dari tanggal ..….... s.d ….…… bertempat di …….……………………..…
Tempat, Tanggal, Bulan dan Tahun

BUPAT BA!"#,
!A$A %&#AS





































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Baian Be&a(an STTPP
AGENDA PEMBELAJARAN
T E M A
Um.m ! 8%i+en+.(an Ba%an Di(&a+ De-%a'i9 FFF"FFFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""FFFFFFFFFFF"FF"
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"F""""""""""""""""""""""""""""""""""""""""""""""""
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"F"""""""""""""""""""""""""""""""""""""""""""""""""
K#.*.* ! 8%i+en+.(an 0&e# -en,e&ena'a %enan mena2. -a%a +ema .m.m %an i**.e a2+.a& *e+em-a+9 ""FFFFFFFFF
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF""""""""""""""""""""""""""""""""""""""""""""""""FFFFF"
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""""

Tem-a+, Tana&, B.&an %an Ta#.n
KEPALA BADAN KEPEGA7AIAN DAERAH
FFFFFFFFFFFF,
NAMA PEDABAT
PANGKAT
NIP"



































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7
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7
1

BUPATI BANGLI
SURAT TANDA TAMAT PENDIDIKAN DAN PELATIHAN
N0m0' ! """""""""""""""""""""<""""""""""""""""""""<DDN
B.-a+i Ban&i Be'%a*a'(an PP N0m0' 101 Ta#.n 2000, %an Ke-.+.*an Men+e'i Da&am Nee'i N0m0' :6 Ta#.n 2002 %an (e+en+.an3(e+en+.ann,a
men,a+a(an ba#$a !
Nama ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
Tem-a+<Tana& &a#i' ! """""""""""""""""""""""""""""""""""<""""""""""""""""""""""""""""""""""
NIP<NRP ! 000000000<0000
Pa* )0+0 Pan(a+<G0&" R.an ! """"""""""""""""""""""""""""""""""<""""""""""""""""""""""""""""""""""""
4 A 4 Daba+an ! """""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
In*+an*i ! """"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
L U L U S
K.a&i)i(a*i !
Pa%a Pen%i%i(an %an Pe&a+i#an """""""""""""""""""""" Kab.-a+en Ban&i ,an %i*e&ena'a(an 0&e# Ba%an Pen%i%i(an %an Pe&a+i#an Kab.-a+en<K0+a
%i """""""""""""""""""""""""""""""""""""""" %a'i +ana& """""""""" *am-ai %enan """""" ,an me&i-.+i """"""""""""""""""""""""""""""""""""

Tem-a+, Tana&, B.&an %an Ta#.n
a"n" BUPATI BANGLI
KEPALA BADAN KEPEGA7AIAN DAERAH,

NAMA PEDABAT




































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7
1
Baian Be&a(an STTP P
AGENDA PEMBELAJARAN
T E M A
Um.m ! 8%i+en+.(an Ba%an Di(&a+ De-%a'i9 FFF"FFFFFFFFFFFFFFFFFFF"FF"""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
F"""""""""""""""""""""""""""""""""""""""""""""""""""FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"FFFFFFFF
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"FFFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""""""
K#.*.* ! 8%i+en+.(an 0&e# -en,e&ena'a %enan mena2. -a%a +ema .m.m %an i**.e a2+.a& *e+em-a+9 F""""""""""""""""""""""""""""""""""""""""""""FFF
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""F
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF"""""""""""""""""""""""""""""""""""""""""""""""F

Tem-a+, Tana&, B.&an %an Ta#.n
KEPALA BIDANG DIKLAT
FFFFFFFFFFFF,

NAMA PEDABAT
PANGKAT
NIP"



































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7
1
"5
B" PENEMPATAN a.n, u.3, u.", Pl/, Plh DAN Pj
1" Pen.naan Ha"n"I!

a"n" BUPATI BANGLI
SEKRETARIS DAERAH,
NAMA PEDABAT
PANGKAT
NIP
a"n" KEPALA BADAN<DINAS""""""
SEKRETARIS BADAN<DINAS,
NAMA PEDABAT
PANGKAT
NIP
a"n" @AMAT """""""""""""""""
SEKRETARIS @AMAT,
NAMA PEDABAT
PANGKAT
NIP
a"n" LURAH """"""""""""""""
SEKRETARIS LURAH,
NAMA PEDABAT
PANGKAT
NIP

2" Pen.naan H ."b"I!


a"n" BUPATI BANGLI
SEKRETARIS DAERAH
."b"
ASISTEN ADMINISTRASI PEMERINTAHAN,
NAMA PEDABAT
PANGKAT
NIP
a"n" BUPATI BANGLI
SEKRETARIS DAERAH
."b"
KEPALA BAGIAN UMUM,
NAMA PEDABAT
PANGKAT
NIP



































7
1
"6
:" Pen.naan HP&+I!
P&+" BUPATI BANGLI
7AKIL BUPATI,
NAMA PEDABAT
4" Pen.naan HP&#I !
P&#" BUPATI BANGLI
7AKIL BUPATI,
NAMA PEDABAT
5" Pen.naan HP=I !
P=" BUPATI BANGLI,
NAMA PEDABAT
1. PARA& DAN PENULISAN NAMA.
1. Pemb.b.#an Pa'a) Hie'a'(#i* !
a. na*(a# %ina* *ebe&.m %i+an%a+anani 0&e# B.-a+i, $a(i& B.-a+i,
*e('e+a'i* %ae'a#, a*i*+en, *e('e+a'i* DPRD, (e-a&a %ina*, (e-a&a ba%an,
in*-e(+.' %an %i'e(+.' '.ma# *a(i+ .m.m #a'.* %i-a'a) +e'&ebi# %a#.&. 0&e#
ma(*ima& +ia 0'an -e=aba+ *e2a'a be'=en=an .n+.( be'+an.n =a$ab
+e'#a%a- *.b*+an*i, 'e%a(*i %an -en.&i*an na*(a# %ina* +e'*eb.+ *e*.ai
%enan +.a* -0(0( %an ).n*in,a, -enem-a+an -a'a) +e'*eb.+ -a%a
&emba' +e'a(#i' na*(a# %ina* *e*.ai a'a# =a'.m =am %im.&ai %a'i *ebe&a# (i'i
nama -e=aba+ ,an a(an menan%a+anani"
b" na*(a# %ina* ,an (0n*e-n,a %ib.a+ 0&e# -e=aba+ ,an a(an
menan%a+anani na*(a# %ina* +e'*eb.+ +i%a( meme'&.(an -a'a)"
c. -a'a) .n+.( *.'a+ -e'in+a# -e'=a&anan %ina*, %ib.b.#(an -a%a &emba'
-e'+ama"
d. .n+.( (eamanan i*i na*(a# %ina* ,an =.m&a#n,a &ebi# %a'i *a+.
#a&aman, *ebe&.m na*(a# %ina* +e'*eb.+ %i+an%a+anani 0&e# -e=aba+ ,an
be'$enan ma(a #a'.* %ib.b.#(an -a'a) -e=aba+ -en0&a# -a%a *.%.+
(anan ba$a# *e+ia- #a&aman"
""
e" na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.( #.(.m<*.'a+ ,an &ebi#
%a'i *a+. &emba', *e+ia- &emba'n,a %i -a'a) -a%a -0=0( (i'i (e'+a* baian
ba$a#"
)" na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+ ,an mem-.n,ai &am-i'an,
-a%a &emba' &am-i'an %i-0=0( *ebe&a# (anan a+a* %i+.&i* &am-i'an!*.'a+,
n0m0' %an +ana& *e'+a -a%a baian a(#i' *ebe&a# (anan ba$a#
%i+an%a+anani 0&e# -e=aba+ ,an be'$enan"
2. Pemb.b.#an -a'a) (00'%ina*i !
a. na*(a# %ina* %a&am ben+.( %an *.*.nan -'0%.(
#.(.m ,an ma+e'in,a men,an(.+ (e-en+inan .ni+ &ain *ebe&.m
%i+an%a+anani 0&e# -e=aba+ ,an be'$enan #a'.* %i-a'a) +e'&ebi# %a#.&.
0&e# .ni+ -en0&a#, .ni+ &ain ,an +e'(ai+ %an baian #.(.m -a%a *e+ia-
&emba' na*(a#"
b. na*(a# %ina* %a&am ben+.( %an *.*.nan *.'a+ ,an ma+e'in,a
men,an(.+ (e-en+inan .ni+ &ain *ebe&.m %i+an%a+anani 0&e# -e=aba+
,an be'$enan #a'.* %i-a'a) +e'&ebi# %a#.&. 0&e# .ni+ -en0&a#, .ni+ &ain
,an +e'(ai+ -a%a &emba' +e'a(#i' na*(a#"
2" -a'a) K00'%ina*i %ib.a+ %a&am ben+.( *+em-e& -e'*ei em-a+"
@0n+0# -a'a) #ie'a'(#i* %a&am ben+.( *ea'a# =a'.m =am!
889 BUPATI BANGLI 89
899 NAMA
@0n+0# -a'a) #ie'a'(#i* %a&am ben+.( ma+'i(!
@0n+0# -a'a) (00'%ina*i !

PARA> KOORDINASI
Baian FF
Baian FF
Baian F""
%*+
PARA> KOORDINASI
Dina* FF
Ba%an FF
Kan+0' F""
%*+
PARA> HIERARKHIS
Se(%aF"""
A**" F"""F
Bi'0<Ba"""
%*+
"#
:" Pen.&i*an nama -e=aba+ ,an be'$enan menan%a+anani na*(a# %ina*!
a. -en.&i*an nama B.-a+i %an nama $a(i& $a(i&
B.-a+i -a%a na*(a# %ina* %a&am ben+.( -'0%.( #.(.m +i%a( men.na(an
e&a'/
b. -en.&i*an nama B.-a+i %an nama $a(i& $a(i&
B.-a+i -a%a na*(a# %ina* %a&am ben+.( *.'a+ %a-a+ men.na(an e&a'/
c. nama -e=aba+ ,an men%.%.(i =aba+an *+'.(+.'a&
%an ).n*i0na& men.na(an e&a', NIP %an -an(a+"
D. BENTUK UKURAN DAN ISI STEMPEL.
Yan men.na(an &amban"
M M 2,7 2m :,6 2m 4 2m

Lamban Nea'a < Dae'a# Kab.-a+en Ban&i
Yan +i%a( men.na(an &amban
1 2m 2,7 2m :,6 2m 4 2m
1" STEMPEL JABATAN DAN STEMPEL SKPD.
a" 20n+0# *+em-e& =aba+an!
"$

b" *+em-e& *e('e+a'ia+ %ae'a# %an *e('e+a'ia+ %e$an!
2" *+em-e& *a+.an (e'=a -e'an(a+ %ae'a#!
%" *+em-e& (e2ama+an %an (e&.'a#an!
e" *+em-e& .ni+ -e&a(*ana +e(ni* %ae'a#!
#%
)" *+em-e& *a+.an (e'=a -e'an(a+ %ae'a# .n+.( (e-e'&.an +e'+en+."
0,5 2m 1,2 2m 1,7 2m 1,6 2m
@0n+0# *+em-e& .n+.( KTP %enan *(a&a 4 ! 1"
E. BENTUK, UKURAN DAN ISI K0P NASKAH DINAS.
1" Pe'ban%inan #.'.) -a%a (0- na*(a# %ina* an+a'a +.&i*an nama -eme'in+a#
%ae'a# %an nama *a+.an (e'=a -e'an(a+ %ae'a# a%a&a# : ! 4"
a" +.&i*an nama -eme'in+a# %ae'a# %enan #.'.) a'ia& 14"
b" +.&i*an nama *a+.an (e'=a -e'an(a+ %ae'a# %enan #.'.) a'ia& 16"
#1
2" Ben+.( %an i*i (0- na*(a# %ina* *e-e'+i -a%a 20n+0# be'i(.+ !
20n+0# 1 ! K0- na*(a# %ina* B.-a+i"
BUPATI BANGLI
#2
Da&an B'i=en N.'a# Rai N0":0 Ban&i, P'0;in*i Ba&i
Te&e-0n 80:449 FF"", >a(* 80:449 FFF, $$$""""""""""""""""
1on/oh 8 * Ko" na,+ah -ina, Se+re/aria/ Daerah Ka3u"a/en Bangli
PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DAERAH
Jl. Brigjen Ngurah Rai No !. Bangli Ko-e Po, :!$9
Tel"on. #!$$% ............ &a' #!$$% ...............
(((. .................................... e)ail* .............................................
1on/oh * Ko" na,+ah -ina, ,e+re/aria/ De(an Per(a+ilan Ra+5a/ Daerah
PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DE;AN PER;AKILAN RAK<AT DAERAH
Jl. Brigjen Ngurah Rai No. 8 Bangli Ko-e Po, :!$9
Tel"on. #!$$% ..... &a' #!$$% .....
(((. .................................... e)ail* .............................................
1on/oh = * Ko" na,+ah -ina, Sa/uan Kerja Perang+a/ Daerah.
PEMERINTAH KABUPATEN BANGLI
BADAN PEREN1ANAAN PEMBANGUNAN DAERAH
Jl. .................. No. ...... Bangli Ko-e Po, :!$9
Tel"on. #!$$% ........... &a' #!$$% .............
(((. ..................................... e)ail* ...........................................
PEMERINTAH KABUPATEN BANGLI
DINAS TATA K0TA
#3
Jl. Sri(ija5a No. 8 Bangli Ko-e Po, :!$9
Tel"on. #!$$% .............&a' #!$$% ................
(((. ................... e)ail* ...................................
1on/oh > * Ko" na,+ah -ina, +e.a)a/an -an +elurahan.
PEMERINTAH KABUPATEN BANGLI
KE1AMATAN BANGLI
Jl. Ngurah rai No. 8?9 Bangli Ko-e Po, :!$9
Tel"on. #!$$% ............ &a' #!$$% ..............
(((. ................... e)ail* ...................................
PEMERINTAH KABUPATEN BANGLI
KE1AMATAN BANGLI
KELURAHAN KA;AN
Jl. Ra5a Brigjen Ngurah Rai No. 9> Bangli Ko-e Po, :!$9
Tel"on. #!$$% ...........&a' #!$$% .............
(((. ................... e)ail* ...................................
#4
&. BENTUK, UKURAN DAN ISI SAMPUL NASKAH DINAS.
UKURAN HURU>"
Pe'ban%inan #.'.) -a%a *am-.& na*(a# %ina* an+a'a +.&i*an nama -eme'in+a#
%ae'a# %an +.&i*an nama *a+.an (e'=a -e'an(a+ %ae'a# a%a&a# : ! 4
a" +.&i*an nama -eme'in+a# %ae'a# %enan #.'.) a'ia& 14"
b" +.&i*an nama *a+.an (e'=a -e'an(a+ %ae'a# %enan #.'.) a'ia& 16"
@0n+0# 1 ! K0- *am-.& na*(a# %ina* B.-a+i"
8a'.%a (.nin ema*9
BUPATI BANGLI
Da&an B'i=en N.'a# Rai, N0m0' :0 Ban&i, P'0;in*i Ba&i K0%e P0* 6041:
Te&e-0n 80:449 """"""""""", >a(* 80:449 """""""""""", $$$""""""""
Ke-a%a
N0m0' ! F"""<F""<F<F" Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
@0n+0# 2 ! K0- *am-.& na*(a# %ina* *e('e+a'ia+ %ae'a# %an *e('e+a'ia+ DPRD
PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DAERAH
Jl. Brigjen Ngurah Rai No. ! Bangli Ko-e Po, :!$9
Tel"on. #!$$% ......... &a' #!$$% .............
(((. ................... e)ail* ................................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
#5
PEMERINTAH KABUPATEN BANGLI
SEKRETARIAT DPRD
Jl. Brigjen Ngurah Rai No. 8 Bangli Ko-e Po, :!$9
Tel"on. #!$$% ..... &a' #!$$% .....
(((. ................... e)ail* ..............................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
@0n+0# : ! K0- *am-.& na*(a# %ina* *a+.an (e'=a -e'an(a+ %ae'a#"
PEMERINTAH KABUPATEN BANGLI
DINAS KESEHATAN
Jl. Brigjen Ngurah Rai No. 8: Bangli Ko-e Po, :!$9
Tel"on. #!$$% .......... &a' #!$$% ..........
(((. ........................... e)ail* 2222..............
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
PEMERINTAH KABUPATEN BANGLI
BADAN KEPEGA;AIAN DAERAH
Jl. Brigjen Ngurah Rai No. ! Bangli Ko-e Po, :!$9
Tel"on. #!$$% ........... &a' #!$$% ...........
(((. ................... e)ail* ...................................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
#6
PEMERINTAH KABUPATEN BANGLI
BADAN PERPUSTAKAAN, ARSIP DAN D0KUMENTASI
Jl. Le//u Ano) Bangli Ko-e Po, :!$9
Tel"on. #!$$%........... &a' #!$$% 2.....
(((. ........................ e)ail* 222................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
@0n+0# 4 ! K0- *am-.& na*(a# %ina* (e2ama+an %an (e&.'a#an"
PEMERINTAH KABUPATEN BANGLI
KE1AMATAN BANGLI
Jl. Brigjen Ngurah RaiNo. >@ Bangli Ko-e Po, :!8@
Tel"on. #!$$% .......... &a' #!$$% ..........
(((......................... e)ail* .....................................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
PEMERINTAH KABUPATEN BANGLI
KE1AMATAN BANGLI
KELURAHAN KA;AN
Jl. Brigjen Ngurah Rai No. 9> Bangli Ko-e Po, :!$9
Tel"on. #!$$% ........ &a' #!$$% 2..
(((. ............................. e)ail* .................................
Ke-a%a
N0m0' ! F"F"<F""<F<F Y+#" S%'" FFFFFFFFF
S+em-e& %i K
FFFFFFF
K0%e P0*
G. BENTUK, UKURAN DAN ISI PAPAN NAMA.
#"
9. BENTUK.
Pa-an nama *a+.an (e'=a -e'an(a+ %ae'a# be'ben+.( em-a+ -e'*ei -an=an
be'ben+.( *ei em-a+"
@0n+0# !
8. UKURAN.
Pe'ban%inan .(.'an #.'.) : ! 4"
a. .(.'an #.'.) H : H .n+.( +.&i*an Peme'in+a# Kab.-a+en Ban&i"
b. .(.'an #.'.) H 4 H .n+.( +.&i*an nama *a+.an (e'=a -e'an(a+ %ae'a#"
##
. BAHAN.
1" Ba#an -a-an nama *a+.an (e'=a -e'an(a+ %ae'a# %i*e*.ai(an %enan
(eb.+.#an %ae'a#, mi*a&n,a %a'i ba#an (a,., be+0n, *en<-&a+ %an &ain
*ebaain,a"
2" Ba#an #.'.) -a-an nama %ia+.' *e*.ai (eb.+.#an, %a-a+ men.na(an
2a+ a+a. %a'i ba#an &ain *e-e'+i *en<-&a+ a+a. *emen %an &ain *ebaain,a"
1on/oh 9 * Pa"an na)a Kan/or Bu"a/i"
1on/oh 8 * Pa"an na)a Sa/uan Kerja Perang+a/ Daerah.
KANTOR BUPATI BANGLI
kenÓ(o bupti b\ÞÞi .
Da&an """""""""""""""N0m0'""""Ban&i K0%e P0* """"""""""
Te&e-0n 80:449 """"""""""""", >a(* 80:449 """""""""""""", $$$" """""""""""""""""""""""
PEMERINTAH KABUPATEN BANGLI
p)m)rinÓ; kbupetn/ b\ÞÞi ,
DINAS PEKERJAAN UMUM
Da&an """""""""""""""N0m0'""""Ban&i K0%e P0* """"""""""
Te&e-0n 80:449 """"""""""""", >a(* 80:449 """""""""""""", $$$" """""""""""""""""""""""
#$
1on/oh * Pa"an na)a Ke.a)a/an -an Kelurahan.
PEMERINTAH KABUPATEN BANGLI
p)m)rinÓ; kbupetn/ b\ÞÞi ,
KECAMATAN BANGLI
k)cmtn/ b\ÞÞi ,
Da&an """""""""""""""N0m0'""""Ban&i K0%e P0* """"""""""
Te&e-0n 80:449 """"""""""""", >a(* 80:449 """""""""""""", $$$" """""""""""""""""""""""
PEMERINTAH KABUPATEN BANGLI
p)m)rinÓ; kbupetn/ b\ÞÞi ,
KECAMATAN BANGLI
k)cmtn/ b\ÞÞi ,
KELURAHAN KAWAN
k)lurhn/ kwn/ ,
Da&an """""""""""""""N0m0'""""" Ban&i K0%e P0* """"""""""
Te&e-0n 80:449 """"""""""""", >a(* 80:449 """""""""""""", $$$" """""""""""""""""""""""
$%
1on/oh = * Pa"an na)a 5ang /erle/a+ ,a/u a/a"7,a/u +o)"le+.
BUPATI BANGLI,
I MADE GIANYAR
PEMERINTAH KABUPATEN BANGLI
p)m)rinÓ; kbupetn/
b\ÞÞi ,
1. DINAS TATA KOTA
1 ó in!/ tt
ekot ,
2. BADAN LINGKUNGAN HIDUP

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