| No. | Nama | Paraf |
|---|---|---|
| 1 | MUKODIM | |
| 2 | MUGIYANA | |
| 3 | SUKANTI | |
| 4 | CIPTO PRAYITNO | |
| 5 | EDI WAHYONO | |
| 6 | HERMAWAN | |
| 7 | TRIYONO | |
| 8 | SUKIRDI | |
| 9 | AKHMAD SAFIIN | |
| 10 | SIYAMAH | |
| 11 | MARTINAH | |
| 12 | SURATMIYATI | |
| 13 | RUSINI | |
| 14 | MARWITO | |
| 15 | SUTARNO | |
| 16 | SLAMET BEJO | |
| 17 | SURAMI | |
| 18 | PAWIT | |
| 19 | HERI SUPRIYONO | |
| 20 | ROHMAT BASUKI | |
| 21 | ISMAIL | |
| 22 | IMRON | |
| 23 | MUHAMAD DONI SETIAWAN |