BERITA ACARA

MUSYAWARAH KOORDINASI ......................................

DESA ......................................

Berkaitan dengan Keputusan Kepala Desa tentang Koordinasi ...................................... dan

penetapan Peraturan Desa di Desa ...................................... Kecamatan Pangkalan Susu Kabupaten
Langkat Provinsi Sumatera Utara tentang pengangkatan perangkat desa yaitu Sekretaris Desa dan
Kaur Pemerintahan pada :

Hari dan Tanggal : Rabu, 24 Mei 2017

Jam : 09.30 Wib
Tempat : Aula Kantor Desa ......................................

Telah diadakan acara musyawarah desa tentang Keputusan Kepala Desa dan Penetapan Peraturan
Desa tentang Koordinasi ...................................... yang dihadiri oleh: Kepala Desa, Kepala Unsur
Perangkat Desa, LPMD, Tokoh Masyarakat, Kepala ......................................,
Pengurus ......................................, dan BPD sebagaimana daftar hadir terlampir.

Demikian Berita Acara ini dibuat dengan penuh tanggung jawab untuk dipergunakan sebagaimana
mestinya.

Adapun materi yang dibahas dalam musyawah ini serta yang bertindak selaku unsur pimpinan rapat
adalah :

A. Materi
Keputusan Kepala Desa ...................................... dan Penetapan Peraturan Desa tentang
status yayasan milik desa, yang meliputi bidang musyawarah :
1. Koordinasi ......................................
2. Status Kepemilikan Aset Desa
3. Peraturan Desa Tentang yayasan sebagai aset desa.

B. Pimpinan Musyawarah Dan Narasumber

Pemimpin Rapat : ....................
Notulen : ...................
Narasumber/Pemateri : ..................

Setelah dilakukan pembahasan terhadap materi, selanjutnya seluruh peserta musyawarah Desa
menyepakati beberapa hal yang berketetapan menjadi kesepakatan akhir dari musyawarah Desa
yaitu;
1. ...........................................................................................................................
2. ...........................................................................................................................
3. ...........................................................................................................................
4. ...........................................................................................................................
5. ...........................................................................................................................
6. ...........................................................................................................................

Demikian Berita Acara ini dibuat dan disahkan dengan penuh tanggungjawab agar dapat
dipergunakan sebagaimana mestinya.

..................., 24 Mei 2017

Pimpinan Rapat Notulen

........................ ............................................
Mengetahui
Kepala Desa ......................................

..................................
 DAFTAR HADIR PESERTA RAPAT
BADAN PEMUSYAWARAHAN DESA (BPD) DESA ......................................
KECAMATAN PANGKALAN SUSU TAHUN 2017

No. Nama Jabatan Tanda Tangan

1 1.

2 2.

3 3.

4 4.

5 5.

6 6.

7 7.

8 8.

9 9.

10 10.

......................................, 25 Mei
2017
Mengetahui,
Kepala Desa ...................................... Ketua BPD
Desa ......................................

S U PA R D I ISMAIL
 DAFTAR HADIR PESERTA RAPAT
BADAN PEMUSYAWARAHAN DESA (BPD) DESA ......................................
KECAMATAN PANGKALAN SUSU TAHUN 2017

Notulen Rapat Musyawarah :

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......................................, 25 Mei
2017
Notulen
Mengetahui,
Ketua BPD
SONY SINAGA

I S MAI L