| No. | Nama | Paraf |
|---|---|---|
| 1 | SUSWATI | |
| 2 | ACHMAT SHUKUR | |
| 3 | RAKHMAT FERRY NUGROHO | |
| 4 | DARWANTO | |
| 5 | RAME | |
| 6 | NITI PRAYITNO | |
| 7 | SLAMET | |
| 8 | SARWIYATI | |
| 9 | SUMARYO | |
| 10 | DULHADI | |
| 11 | JUWARNO | |
| 12 | PURWANTO | |
| 13 | RAHMADI | |
| 14 | MUHLASIN | |
| 15 | SINAH | |
| 16 | PARING | |
| 17 | SURITNO | |
| 18 | SUHADI | |
| 19 | DARWITO | |
| 20 | GIMIN | |
| 21 | MULUD | |
| 22 | RUWADI | |
| 23 | KUMPUL | |
| 24 | RUJITO | |
| 25 | HARTINI |