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lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \
tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \
af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025
\cf1 : 46 Tahun}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \
af6 \hich \af0 \loch \f0 \cf1 \par }\pard \plain \fi0 \li720 \ri0 \sa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx360 \tqc \
tx426 \tql \tx720 \itap0 \ls1 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \
af4 \cf1 {\listtext \pard \plain \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \
af4 \cf1 \f2 5.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025
\ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \alang1025 \cf1 Jenis Kelamin}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033
\langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \
afs24
\ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 :
Laki-Laki}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \
hich \af0 \loch \f0 \cf1 \par }\pard \plain \fi0 \li720 \ri0 \sa0 \sl360 \slmult1 \
widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx360 \tqc \tx426 \tql
\tx720 \itap0 \ls1 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\
listtext \pard \plain \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 \f2
6.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch
\af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \
alang1025 \cf1 Pekerjaan}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \
langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 :
Wiraswasta}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \
hich \af0 \loch \f0 \cf1 \par }\pard \plain \fi0 \li720 \ri0 \sa0 \sl360 \slmult1 \
widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx360 \tqc \tx426 \tql
\tx720 \itap0 \ls1 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\
listtext \pard \plain \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 \f2
7.\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch
\af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \
alang1025 \cf1 Alamat}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \
langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \
tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \
af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025
\cf1 : Munung, 01/01, Bekare, Bungkal, Ponorogo}{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \cf1 \par }\
pard \plain \li720 \ri0 \sa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin720 \rin0 \tqc \tx426 \tql \tx720 \itap0 \ls0 \fs22 \rtlch \ltrch \
dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \cf1 \par }\pard \plain \li0 \ri0 \sa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tqc \tx426 \
itap0 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \
af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \
loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\
rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \
hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1
\tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \
af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025
\cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \
alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025
\ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \
rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \
langfe1033 \langfenp1033 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 }{\rtlch \fcs1 \af0 \afs24 \
ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \cf1 \par }\pard \
plain \qj \li0 \ri0 \sa200 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin0 \rin0 \itap0 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4
\cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \
af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025
\cf1 Dengan ini menyatakan dengan sebenarnya bahwa saya }{\rtlch \fcs1 \af0 \
afs24 \ltrch \fcs0 \i1 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \
f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 bukan merupakan
anggota Partai Politik}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \
langfe1033 \langfenp1033 \alang1025 \cf1 .}{\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \cf1
\par }\pard \plain \qj \li0 \ri0 \sa200 \sl360 \slmult1 \widctlpar \aspalpha \
aspnum \adjustright \lin0 \rin0 \tql \tx6946 \tql \tx7088 \tql \tx7230 \itap0 \fs22
\rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \
ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \
lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 Demikian Surat
Pernyataan ini dibuat dengan sebenarnya dan apabila ternyata di kemudian hari
terbukti tidak benar, saya bersedia menerima konsekuensi hukum sesuai dengan
ketentuan peraturan perundang-undangan yang berlaku.}{\rtlch \fcs1 \af0 \afs24 \
ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \cf1 \par }\pard \
plain \qr \li4230 \ri76 \sa200 \sl360 \slmult1 \nowidctlpar \aspalpha \aspnum \
adjustright \lin4230 \rin76 \itap0 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \
loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \
ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \
langfenp1033 \alang1025 \cf1 Bekare,15 Desember 2023}{\rtlch \fcs1 \af0 \afs24 \
ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \cf1 \par }\pard \plain \qc \li5103 \ri-25 \sb8 \sa200 \sl360 \slmult1 \
nowidctlpar \aspalpha \aspnum \adjustright \lin5103 \rin-25 \itap0 \fs22 \rtlch \
ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \
fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \af0 \loch \f0 \lang1033 \
langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 Yang membuat pernyataan}{\
rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \
loch \f0 \cf1 \par }\pard \plain \li0 \ri-25 \sb8 \sa200 \sl360 \slmult1 \
nowidctlpar \aspalpha \aspnum \adjustright \lin0 \rin-25 \itap0 \fs22 \rtlch \ltrch
\dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \
fs22 \rtlch \ltrch \dbch \af4 \hich \af0 \loch \af0 \cf1 {\shp {\*\shpinst \
shpleft5200 \shptop20 \shpright6670 \shpbottom860 \shpfhdr0 \shpbxmargin \
shpbxignore \shpbypara \shpbyignore \shpwr3 \shpwrk0 \shpfblwtxt0 \shpz0 \
shplid1026 {\sp {\sn shapeType}{\sv 75}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}
{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv 1}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn
pib}{\sv {\pict \piccropl0 \piccropr0 \piccropt0 \piccropb0 \picscalex100 \
picscaley100 \picw98 \pich56 \picwgoal1470 \pichgoal840 \pngblip {\*\blipuid
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195089d01dff6f224bf9ba32fc03006b0a800ad3b1450000000049454e44ae426082}}}{\sp {\sn
pibName}{\sv Image_0}}{\sp {\sn pibFlags}{\sv 10}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\
sn f3DOK}{\sv 0}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fFilled}{\sv 0}}{\sp {\sn
lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 0}}{\sp {\sn wzName}{\sv Picture 2}}{\sp {\
sn posrelh}{\sv 0}}{\sp {\sn fLayoutInCell}{\sv 1}}}{\shprslt {\pict }}}}{\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \hich \af0 \loch \f0 \
cf1 \par }\pard \plain \li0 \ri-25 \sb8 \sa200 \sl360 \slmult1 \nowidctlpar \
aspalpha \aspnum \adjustright \lin0 \rin-25 \itap0 \fs22 \rtlch \ltrch \dbch \af4 \
hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \
ltrch \dbch \af6 \hich \af0 \loch \f0 \cf1 \par }\pard \plain \qc \li5103 \ri-25 \
sb8 \sa200 \sl360 \slmult1 \nowidctlpar \aspalpha \aspnum \adjustright \lin5103 \
rin-25 \itap0 \fs22 \rtlch \ltrch \dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \
fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \dbch \af6 \hich \
af0 \loch \f0 \lang1033 \langnp1033 \langfe1033 \langfenp1033 \alang1025 \cf1 (Budi
Purnomo)}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs24 \rtlch \ltrch \dbch \af6 \
hich \af0 \loch \f0 \cf1 \par }\pard \plain \li0 \ri0 \sa200 \sl276 \slmult1 \
widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \fs22 \rtlch \ltrch \
dbch \af4 \hich \af4 \loch \af4 \cf1 {\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \fs22 \
rtlch \ltrch \dbch \af4 \hich \af0 \loch \f0 \cf1 \par }}