| No. | Nama | Paraf |
|---|---|---|
| 1 | HASANUDIN | |
| 2 | SRIYATI | |
| 3 | M. ABDUL KARIM | |
| 4 | MUTA'AT | |
| 5 | MUGI PAMI | |
| 6 | SUWANDI | |
| 7 | SULASTRIYAH | |
| 8 | MURYONO | |
| 9 | PARMAN | |
| 10 | ISWOYO | |
| 11 | ZAENI | |
| 12 | SARIP | |
| 13 | IMRO KHANIYAH | |
| 14 | MUH ISLAM | |
| 15 | MUHTASUN | |
| 16 | SITI AMINAH | |
| 17 | DAHRI | |
| 18 | NAJIB HALIMI | |
| 19 | DARMAJI | |
| 20 | ABDUL HALIM | |
| 21 | SANIYAH | |
| 22 | MUHAMAD HANAFI | |
| 23 | IRWAN | |
| 24 | MUKIDI | |
| 25 | HARI BAROKAH | |
| 26 | MUHAMMAD FADIL | |
| 27 | MUHAMAD ABDUL CHOLIQ | |
| 28 | NURIYAH | |
| 29 | SITI QOMARIYAH HJ | |
| 30 | MULIYANA GIOFANI |