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REKAP TPK Kecamatan Plumpang (TAHUN 2026)
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BULAN ?
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DESA?
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TANGGAL PENDAMPINGAN *
MM
/
DD
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YYYY
Nama Sasaran Yang Didampingi *
NIK *
ALAMAT RT/RW ? Contoh (01/03) *
Sasaran Yang Di Dampingi  *
Beresiko Atau Tidak Beresiko ? *
Pendampingan KE ? Cth (1) *
TIM Pendamping ? *
Kunjungan Ke ? " Di Isi Angka Saja "  Contoh : 1   *
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