<h4 style="margin: 0; text-align: center;"><span style="text-decoration: underline;">[JUdul_surat]</span></h4>
<p style="margin: 0; text-align: center;">Nomor : [Format_nomor_suraT]<br><br></p>
<p style="text-align: justify; text-indent: 30px;">Yang bertanda tangan di bawah ini [JaBatan] [NaMa_desa], Kecamatan [NaMa_kecamatan], [SeButan_kabupaten] [NaMa_kabupaten], Provinsi [NaMa_provinsi] menerangkan bahwa berdasarkan keterangan dari :</p>
<table style="border-collapse: collapse; width: 100%; height: 118px;" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr style="height: 10px;">
<td style="width: 4.5221%; text-align: center; height: 10px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 10px;">Nama Lengkap</td>
<td style="width: 1.2333%; text-align: center; height: 10px;">:</td>
<td style="width: 62.4872%; height: 10px; text-align: justify;"><strong>[NAma]</strong></td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.5221%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 18px;">Tempat / Tanggal Lahir</td>
<td style="width: 1.2333%; text-align: center; height: 18px;">:</td>
<td style="width: 62.4872%; height: 18px; text-align: justify;">[TtL]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.5221%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 18px;">Umur</td>
<td style="width: 1.2333%; text-align: center; height: 18px;">:</td>
<td style="width: 62.4872%; text-align: justify; height: 18px;">[UsIa]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.5221%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 18px;">Jenis Kelamin</td>
<td style="width: 1.2333%; text-align: center; height: 18px;">:</td>
<td style="width: 62.4872%; height: 18px; text-align: justify;">[Jenis_kelamin]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.5221%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 18px;">Pekerjaan</td>
<td style="width: 1.2333%; text-align: center; height: 18px;">:</td>
<td style="width: 62.4872%; text-align: justify; height: 18px;">[PeKerjaan]</td>
</tr>
<tr style="height: 36px;">
<td style="width: 4.5221%; text-align: center; height: 36px;"> </td>
<td style="width: 31.7575%; text-align: left; height: 36px;">Alamat / Tempat Tinggal<br><br></td>
<td style="width: 1.2333%; text-align: center; height: 36px;">:<br><br></td>
<td style="width: 62.4872%; height: 36px; text-align: justify;">[AlamaT] [Sebutan_desa] [NaMa_desa], Kecamatan [NaMa_kecamatan], [SeButan_kabupaten] [NaMa_kabupaten]</td>
</tr>
</tbody>
</table>
<p style="text-align: justify; text-indent: 30px;">Orang tersebut adalah penduduk [Sebutan_desa] [NaMa_desa], yang mempunyai kendaraan dengan rincian sebagai berikut, sesuai BPKB :<strong><br></strong></p>
<table style="border-collapse: collapse; width: 100%; height: 180px;" border="0" cellspacing="0" cellpadding="0">
<tbody>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Merk / Type</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_merktypE]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Tahun Pembuatan</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_tahun_pembuataN]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Warna</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_warna_kendaraaN]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Nomor Polisi</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_nomor_polisI]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Nomor Mesin</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_nomor_mesiN]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Nomor Rangka</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_nomor_rangkA]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Nomor BPKB</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_nomor_bpkB]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; text-align: center; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Bahan Bakar</td>
<td style="width: 1.20846%; text-align: center; height: 18px;">:</td>
<td style="width: 62.5378%; height: 18px;">[Form_bahan_bakaR]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Isi Silinder</td>
<td style="width: 1.20846%; height: 18px;"> :</td>
<td style="width: 62.5378%; height: 18px;">[Form_isi_silindeR]</td>
</tr>
<tr style="height: 18px;">
<td style="width: 4.53172%; height: 18px;"> </td>
<td style="width: 31.7221%; height: 18px;">Atas Nama</td>
<td style="width: 1.20846%; height: 18px;"> :</td>
<td style="width: 62.5378%; height: 18px;">[Form_atas_namA]</td>
</tr>
</tbody>
</table>
<p style="text-align: justify; text-indent: 30px;">Kendaraan tersebut di atas adalah milik <strong>[NAma]</strong> yang beralamat di <strong>[AlamaT] [Sebutan_desa] [NaMa_desa], Kecamatan [NaMa_kecamatan], [SeButan_kabupaten] [NaMa_kabupaten].</strong> Surat keterangan ini dipergunakan untuk : <strong>[Form_keperluan_pembuatan_suraT]</strong>.</p>
<p style="text-align: justify; text-indent: 30px;">Demikian surat keterangan ini dibuat dengan sebenarnya, untuk dipergunakan sebagaimana mestinya.</p>
<p style="text-align: justify; text-indent: 30px;"> </p>
<table style="border-collapse: collapse; width: 100%;" border="0">
<tbody>
<tr>
<td style="width: 35%; text-align: center;"> </td>
<td style="width: 30%;"> </td>
<td style="width: 35%; text-align: center;">[NaMa_desa], [TgL_surat]</td>
</tr>
<tr>
<td style="width: 35%; text-align: center;">Pemilik</td>
<td style="width: 30%;"> </td>
<td style="width: 35%; text-align: center;">[Atas_namA]</td>
</tr>
<tr>
<td style="width: 35%; text-align: center;"> </td>
<td style="width: 30%;"><br><br><br><br></td>
<td style="width: 35%;"> </td>
</tr>
<tr>
<td style="width: 35%; text-align: center;">[NamA]</td>
<td style="width: 30%;"> </td>
<td style="width: 35%; text-align: center;">[Nama_pamonG]</td>
</tr>
<tr>
<td style="width: 35%;"> </td>
<td style="width: 30%;"> </td>
<td style="width: 35%; text-align: center;">[SEbutan_nip_desa] : [nip_pamong]</td>
</tr>
</tbody>
</table>
<div style="text-align: center;"> </div>