DAFTAR TANDA TERIMA BIAYA PERJALANAN DINAS NON PNS

TAN PENDAMPINGAN PENDATAAN KEMATIAN ( CRVS ) DI WILAYAH KERJA

PUSKESMAS KELAYAN TIMUR
BULAN : SEPTEMBER 2018

No Nama Tempat Tujuan Tanggal Jlh Hari Biaya Jumlah Tanda Tangan
Pelaksanaan Per Hari Diterima
(Rp.) (Rp.)

1 20-Sep 1 Hr 50,000 50,000 1 ..............

2 1 Hr 50,000 50,000 2 ..............

3 1 Hr 50,000 50,000 3 ..............

4 1 Hr 50,000 50,000 4 ..............

5 1 Hr 50,000 50,000 5 ..............

6 1 Hr 50,000 50,000 6 ..............

7 1 Hr 50,000 50,000 7 ..............

8 1 Hr 50,000 50,000 8 ..............

9 1 Hr 50,000 50,000 9 ..............

10 1 Hr 50,000 50,000 10 ..............

11 1 Hr 50,000 50,000 11 ..............

12 1 Hr 50,000 50,000 12 ..............

13 1 Hr 50,000 50,000 13 ..............

14 1 Hr 50,000 50,000 14 ..............

15 1 Hr 50,000 50,000 15 ..............

16 1 Hr 50,000 50,000 16 ..............

17 1 Hr 50,000 50,000 17 ..............

18 1 Hr 50,000 50,000 18 ..............

19 1 Hr 50,000 50,000 19 ..............

20 1 Hr 50,000 50,000 20 ..............

21 1 Hr 50,000 50,000 21 ..............

22 1 Hr 50,000 50,000 22 ..............

23 1 Hr 50,000 50,000 23 ..............

24 1 Hr 50,000 50,000 24 ..............

25 1 Hr 50,000 50,000 25 ..............

26 1 Hr 50,000 50,000 26 ..............

27 1 Hr 50,000 50,000 27 ..............

28 1 Hr 50,000 50,000 28 ..............

29 1 Hr 50,000 50,000 29 ..............

30 1 Hr 50,000 50,000 30 ..............

31 1 Hr 50,000 50,000 31 ..............

32 1 Hr 50,000 50,000 32 ..............

33 1 Hr 50,000 50,000 33 ..............

34 1 Hr 50,000 50,000 34 ..............

35 1 Hr 50,000 50,000 35 ..............

36 1 Hr 50,000 50,000 36 ..............

37 1 Hr 50,000 50,000 37 ..............

38 1 Hr 50,000 50,000 38 ..............

39 1 Hr 50,000 50,000 39 ..............

40 20-Sep 1 Hr 50,000 50,000 40 ..............

41 1 Hr 50,000 50,000 41 ..............

42 1 Hr 50,000 50,000 42 ..............

43 1 Hr 50,000 50,000 43 ..............

44 1 Hr 50,000 50,000 44 ..............

45 1 Hr 50,000 50,000 45 ..............

46 1 Hr 50,000 50,000 46 ..............

47 1 Hr 50,000 50,000 47 ..............

48 1 Hr 50,000 50,000 48 ..............

49 1 Hr 50,000 50,000 49 ..............

50 1 Hr 50,000 50,000 50 ..............

51 1 Hr 50,000 50,000 51 ..............

52 1 Hr 50,000 50,000 52 ..............

53 1 Hr 50,000 50,000 53 ..............

54 1 Hr 50,000 50,000 54 ..............

55 1 Hr 50,000 50,000 55 ..............

56 1 Hr 50,000 50,000 56 ..............

57 1 Hr 50,000 50,000 57 ..............

58 1 Hr 50,000 50,000 58 ..............

59 1 Hr 50,000 50,000 59 ..............

60 1 Hr 50,000 50,000 60 ..............

Jumlah
3,000,000
Banjarmasin, 2018
Mengetahui, Di Bayar,
Kepala Puskesmas Bendahara Pengeluaran

dr.Hj Sri Pramudian K Corrie Firdhiana I.P,A.Md

NIP. 19780607 200701 2 016 NIP.19860509 201001 2 011
 DAFTAR TANDA TERIMA BIAYA PERJALANAN DINAS NON PNS
KEGIATAN PENDAMPINGAN PENDATAAN KEMATIAN ( CRVS ) DI WILAYAH KERJA
PUSKESMAS KELAYAN TIMUR
BULAN : SEPTEMBER 2018

Tanggal Jlh Hari Biaya Jumlah

No Nama Tempat Tujuan Pelaksanaan Per Hari Diterima Tanda Tangan
(Rp.) (Rp.)

1 H.Zainal Hakim Jl.Kelayan B Gg.Babussalam RT.01 24 September 2018 1 Hr 50,000 50,000 1 ..............

2 Ilham Murjani Jl.Kelayan B. Gg.Kurnia RT.02 24 September 2018 1 Hr 50,000 50,000

3 Siti Hajar Jl.Kelayan B.Gg Kurnia RT.03 24 September 2018 1 Hr 50,000 50,000 3 ..............

4 Hasan Jl.Kelayan B. RT.04 24 September 2018 1 Hr 50,000 50,000

5 Masroni Jl.kelayan B Gg.Sederhana RT.05 24 September 2018 1 Hr 50,000 50,000 5 ..............

6 Arifin Jl.Kelayan B Komplek Raudah Rt.06 24 September 2018 1 Hr 50,000 50,000

7 Abdul Hadi Jl.Kelayan B timur RT.07 24 September 2018 1 Hr 50,000 50,000 7 ..............

8 Sofyan Jl.Kelayan B. Gg. Ampalam Rt.08 24 September 2018 1 Hr 50,000 50,000

9 Aliansyah Jl.Kelayan B. Gg. Jais RT.09 24 September 2018 1 Hr 50,000 50,000 9 ..............

10 Husaini Jl.Kelayan B. Gg. Firdaus RT.10 24 September 2018 1 Hr 50,000 50,000

11 Anang Syamsuri Jl.Kelayan B. Gg. Balai Desa RT.11 24 September 2018 1 Hr 50,000 50,000 11 ..............

12 Nur Rahmat Jl.Kelayan B. Gg. Balai Desa RT.12 24 September 2018 1 Hr 50,000 50,000

13 H.Slamet Jl.Kelayan B. Komplek 10 RT.13 24 September 2018 1 Hr 50,000 50,000 13 ..............

14 Salim Jl.Kelayan B. RT.14 24 September 2018 1 Hr 50,000 50,000

15 Zainal Abidin Jl.Kelayan B. Gg.Amilin RT.15 24 September 2018 1 Hr 50,000 50,000 15 ..............
16 H. Rustam Effendi Jl.Kelayan Kecil RT.16 24 September 2018 1 Hr 50,000 50,000
17 Zainal Abidin Jl.Kelayan Kecil Gg.Amilin RT.17 24 September 2018 1 Hr 50,000 50,000 17 ..............

18 Masrani Jl. Kelayan Kecil RT.19 24 September 2018 1 Hr 50,000 50,000

19 Husin Jl.Kelayan Kecil RT.18 24 September 2018 1 Hr 50,000 50,000 19 ..............

20 Abdul Wahid Jl.Kelayan Kecil Simpang Rungun RT.20 24 September 2018 1 Hr 50,000 50,000

21 Muslim Jl.Gerilya RT.21 24 September 2018 1 Hr 50,000 50,000 21 ..............

22 Muhammad Jl.Kelayan B RT.22 24 September 2018 1 Hr 50,000 50,000

23 Heriansyah Jl.Kelayan B Gg.Serasi RT.23 24 September 2018 1 Hr 50,000 50,000 23 ..............

24 Aliansyah Jl.Kelayan B RT.24 24 September 2018 1 Hr 50,000 50,000

25 Edy.B.Paidy Jl.Kelayan B Gg.Serasi RT.25 24 September 2018 1 Hr 50,000 50,000 25 ..............

26 Junaidi Jl.kelayan B Gg.Darul Aman RT.26 24 September 2018 1 Hr 50,000 50,000

27 Usman Jl.Gerilya RT.27 24 September 2018 1 Hr 50,000 50,000 27 ..............

28 Hasbullah Jl.Gerilya Gg.Yukaba RT.28 24 September 2018 1 Hr 50,000 50,000

29 Husni Rifai Jl.Gerilya Gg.Bambu RT.29 24 September 2018 1 Hr 50,000 50,000 29 ..............

30 Miswandi Jl.Tatah Makmur RT.30 24 September 2018 1 Hr 50,000 50,000

31 H.Mujirin Jl.Gerilya Peradapan RT.31 24 September 2018 1 Hr 50,000 50,000 31 ..............

32 Suni Jl.Tatah Bangkal Luar RT.32 24 September 2018 1 Hr 50,000 50,000

33 M.Jarkasi Jl.Tatah Bangkal Luar RT.33 24 September 2018 1 Hr 50,000 50,000 33 ..............

34 Babastiansyah Jl.Tatah Bangkal Luar Handil Palung Rt.34 24 September 2018 1 Hr 50,000 50,000

35 Syamsudin Jl.Kelayan B Gg.Pinang habang RT.35 24 September 2018 1 Hr 50,000 50,000 35 ..............

36 Damanhuri Jl.Patimura Gg.Padi Luhur RT.36 24 September 2018 1 Hr 50,000 50,000

37 H.Abdul Muis Jl. Kelayan B Gg.Baja RT.37 24 September 2018 1 Hr 50,000 50,000 37 ..............

38 Gazali Jl.Gerilya Peradapan RT.38 24 September 2018 1 Hr 50,000 50,000

39 Murjani Jl.Gerilya Peradapan RT.39 24 September 2018 1 Hr 50,000 50,000 39 ..............

Jumlah
1,950,000

Banjarmasin, 2018

Mengetahui, Di Bayar,

Kepala Puskesmas Bendahara Pengeluaran

dr.Hj Sri Pramudian K Corrie Firdhiana I.P,A.Md

NIP. 19780607 200701 2 016 NIP.19860509 201001 2 011
Tanda Tangan

2 ..............

4 ..............

6 ..............

8 ..............

10 ..............

12 ..............

14 ..............
16 ..............
18 ..............

20 ..............

22 ..............

24 ..............

26 ..............

28 ..............

30 ..............

32 ..............

34 ..............

36 ..............
38 ..............
 DAFTAR TANDA TERIMA BIAYA PERJALANAN DINAS NON PNS
KEGIATAN PENDAMPINGAN PENDATAAN KEMATIAN ( CRVS ) DI WILAYAH KERJA
PUSKESMAS KELAYAN TIMUR
BULAN : SEPTEMBER 2018

Tanggal Jlh Hari Biaya Jumlah

No Nama Tempat Tujuan Pelaksanaan Per Hari Diterima Tanda Tangan
(Rp.) (Rp.)

1 1 Hr 50,000 50,000 1 ..............

2 1 Hr 50,000 50,000 2 ..............

3 1 Hr 50,000 50,000 3 ..............

4 1 Hr 50,000 50,000 4 ..............

5 1 Hr 50,000 50,000 5 ..............

6 1 Hr 50,000 50,000 6 ..............

7 1 Hr 50,000 50,000 7 ..............

8 1 Hr 50,000 50,000 8 ..............

9 1 Hr 50,000 50,000 9 ..............

10 1 Hr 50,000 50,000 10 ..............

11 1 Hr 50,000 50,000 11 ..............

12 1 Hr 50,000 50,000 12 ..............

13 1 Hr 50,000 50,000 13 ..............

14 1 Hr 50,000 50,000 14 ..............

15 1 Hr 50,000 50,000 15 ..............
16 1 Hr 50,000 50,000 16 ..............

17 1 Hr 50,000 50,000 17 ..............

18 1 Hr 50,000 50,000 18 ..............

19 1 Hr 50,000 50,000 19 ..............

20 1 Hr 50,000 50,000 20 ..............

21 1 Hr 50,000 50,000 21 ..............

22 1 Hr 50,000 50,000 22 ..............

23 1 Hr 50,000 50,000 23 ..............

24 1 Hr 50,000 50,000 24 ..............

25 1 Hr 50,000 50,000 25 ..............

26 1 Hr 50,000 50,000 26 ..............

27 1 Hr 50,000 50,000 27 ..............

28 1 Hr 50,000 50,000 28 ..............

29 1 Hr 50,000 50,000 29 ..............

30 1 Hr 50,000 50,000 30 ..............

31 1 Hr 50,000 50,000 31 ..............

32 1 Hr 50,000 50,000 32 ..............

33 1 Hr 50,000 50,000 33 ..............

34 1 Hr 50,000 50,000 34 ..............

35 1 Hr 50,000 50,000 35 ..............

36 1 Hr 50,000 50,000 36 ..............
37 1 Hr 50,000 50,000 37 ..............

38 1 Hr 50,000 50,000 38 ..............

39 1 Hr 50,000 50,000 39 ..............

Jumlah
1,950,000

Banjarmasin, 2018

Mengetahui, Di Bayar,

Kepala Puskesmas Bendahara Pengeluaran

dr.Hj Sri Pramudian K Corrie Firdhiana I.P,A.Md

NIP. 19780607 200701 2 016 NIP.19860509 201001 2 011
 DAFTAR TANDA TERIMA BIAYA PERJALANAN DINAS NON PNS
KEGIATAN PENDAMPINGAN PENDATAAN KEMATIAN ( CRVS ) DI WILAYAH KERJA
PUSKESMAS KELAYAN TIMUR
BULAN : SEPTEMBER 2018

Tanggal Jlh Hari Biaya Jumlah

No Nama Tempat Tujuan Pelaksanaan Per Hari Diterima Tanda Tangan
(Rp.) (Rp.)

1 Abdul Wahid Jl. Kelayan B Tengah RT.01 24 September 2018 1 Hr 50,000 50,000 1 ..............

2 Edi Mulyadi Jl. Kelayan B Tengah Gg.Silaturrahim RT.02 24 September 2018 1 Hr 50,000 50,000

3 Fahrudin Jl. Kelayan B Tengah Gg.An najah RT.03 24 September 2018 1 Hr 50,000 50,000 3 ..............

4 M.Rifani Jl. Kelayan B Tengah Gg.Mufakat RT.04 24 September 2018 1 Hr 50,000 50,000

5 H.Pajeri, S.Pd Jl. Kelayan B Tengah Gg.Berkat RT.05 24 September 2018 1 Hr 50,000 50,000 5 ..............

6 Hj.Kursinah Jl. Kelayan B Tengah Gg.Selamat RT.06 24 September 2018 1 Hr 50,000 50,000

7 Selamat Jl. Kelayan B Tengah Gg.Cahaya Tatas RT.07 24 September 2018 1 Hr 50,000 50,000 7 ..............

8 Akhmad Hanuradi Jl. Kelayan B Tengah Gg.Setia Rahman RT.08 24 September 2018 1 Hr 50,000 50,000

9 Achmad Noor Jl. Kelayan B Tengah Gg.Setia Rahman RT.09 24 September 2018 1 Hr 50,000 50,000 9 ..............

10 Basuni Jl. Kelayan B Tengah Gg.Setia Rahman RT.10 24 September 2018 1 Hr 50,000 50,000

11 Siti Sarinah Jl. Kelayan B Tengah Gg.Setia Rahman RT.11 24 September 2018 1 Hr 50,000 50,000 11 ..............

12 Wahyu Indra Saputra, SE Jl. Kelayan B Tengah Gg.Famili & Melati RT.12 24 September 2018 1 Hr 50,000 50,000

13 Erwansyah Jl. Kelayan B Tengah Gg.Cempaka RT.13 24 September 2018 1 Hr 50,000 50,000 13 ..............

14 H.Rahman Jl. Kelayan B Tengah Gg.Gembira RT.14 24 September 2018 1 Hr 50,000 50,000

15 Yusni Jl. Kelayan B Tengah Gg.Gembira RT.15 24 September 2018 1 Hr 50,000 50,000 15 ..............

16 H.Fredy Jl. Kelayan B Tengah Gg.Gembira RT.16 24 September 2018 1 Hr 50,000 50,000
17 Ibrahim Jl. Kelayan B Tengah Gg.Gembira RT.17 24 September 2018 1 Hr 50,000 50,000 17 ..............
18 Dewi Astuti Jl. Kelayan B Tengah Gg.Bersama RT.18 24 September 2018 1 Hr 50,000 50,000

19 Suriansyah Jl. Kelayan B Tengah Gg.Bersama RT.19 24 September 2018 1 Hr 50,000 50,000 19 ..............

20 Basuni Jl. Kelayan B Tengah Gg.Cermi RT.20 24 September 2018 1 Hr 50,000 50,000

21 Yuspi Rizaldi Jl. Kelayan B Tengah Gg. Mawar RT.21 24 September 2018 1 Hr 50,000 50,000 21 ..............

Jumlah
1,050,000

Banjarmasin, 2018

Mengetahui, Di Bayar,

Kepala Puskesmas Bendahara Pengeluaran

dr.Hj Sri Pramudian K Corrie Firdhiana I.P,A.Md

NIP. 19780607 200701 2 016 NIP.19860509 201001 2 011
Tanda Tangan

2 ..............

4 ..............

6 ..............

8 ..............

10 ..............

12 ..............

14 ..............

16 ..............
18 ..............

20 ..............
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