ABCDEFGHIJKLMNOPQRSTUVWXY
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USULAN RENCANA KEBUTUHAN PEMELIHARAAN BARANG MILIK DAERAH
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(RENCANA PEMELIHARAAN)
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PENGGUNA BARANG ................................. (2)
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TAHUN 20…... (3)
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PEMERINTAH DAERAH: Kota Mojokerto
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PENGGUNA BARANG: ................................................... (4)
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Hal: ............(1)
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NOPROGRAM/KEGIATAN/OUTPUTBARANG YANG DIPELIHARAUSULAN KEBUTUHAN PEMELIHARAANKETERANGAN
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KODE BARANGNAMA BARANGJUMLAHSATUANREGISTER BARANGSTATUS BARANGKONDISI BARANGNAMA PEMELIHARAAN JUMLAHSATUAN
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BRRRB
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123456789101112131416
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A. Program..............................
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 1. Kegiatan.............................
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 a. Output.............................
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xxxxxxxxxxxxx
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xxxxxxxxxxxxx
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 2. Kegiatan.............................
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 a. Output.............................
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xxxxxxxxxxxxx
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xxxxxxxxxxxxx
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 3. Kegiatan.............................
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 a. Output.............................
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xxxxxxxxxxxxx
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xxxxxxxxxxxxx
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B. Program..............................
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 1. Kegiatan.............................
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 a. Output.............................
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xxxxxxxxxxxxx
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xxxxxxxxxxxxx
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 2. Kegiatan.............................
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 a. Output.............................
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xxxxxxxxxxxxx
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xxxxxxxxxxxxx
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56789101112131415161718
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Mojokerto, ...................................... (19)
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Pengguna Barang
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.......................................................................(20)
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......................................................... (21)
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NIP. ........................................ (22)
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