| No. | Nama | Paraf |
|---|---|---|
| 1 | AGUSTINA PUSPITANINGSIH | |
| 2 | ERYUDIN | |
| 3 | FATIMAH | |
| 4 | ADE LISTIYANTO | |
| 5 | MUSLIHUN | |
| 6 | SUNARMAN | |
| 7 | KODIM | |
| 8 | THOHA | |
| 9 | ARIYANTO | |
| 10 | BUDIYANTO | |
| 11 | SUWUN AL MUH SAKIR | |
| 12 | SODIQIN | |
| 13 | JUMINAH | |
| 14 | BADAWI | |
| 15 | RUKIMAH | |
| 16 | SARJONO | |
| 17 | RUSIYAH | |
| 18 | SUNARDI | |
| 19 | SUPADI | |
| 20 | TO'AT | |
| 21 | SURAHMAT | |
| 22 | SUKARDI | |
| 23 | MUHTAR SARONI | |
| 24 | SUTRISNO | |
| 25 | ISYANTO | |
| 26 | ISTOMO | |
| 27 | EKO MULYANTO | |
| 28 | HARTATIK | |
| 29 | MUANAS | |
| 30 | MUH FARODIN | |
| 31 | SUSAH |