KOP
SEKOLAH
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SURAT
IZIN KEPALA SEKOLAH
NOMOR..........................
TENTANG
...................................................................................
Dasar : a. .......................................................................................................................
........................................................................................................................
b. .......................................................................................................................
........................................................................................................................
MEMBERI IZIN:
Kepada :
Nama : .................................................................................................................
NIP : .................................................................................................................
Jabatan : ..................................................................................................................
Alamat : ..................................................................................................................
Untuk : ..................................................................................................................
Ditetapkan di : ...............................
Pada Tanggal : ………………………
Kepala Sekolah,
......................................................
NIP.
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