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Kepada : PUSKESMAS KELAPA
Alamat :
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SURAT JALAN NO : 116/BG/III/25
Dengan kendaraan .......................... No. ..................... kami kirim barang-barang tersebut di bawah ini:

Banyaknya Nama Barang
3 NOTA
Pangkalpinang, 01 November 2026


TANDA TERIMA,


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Hormat Kami,


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