| No. | Nama | Paraf |
|---|---|---|
| 1 | SUKIRNO | |
| 2 | MIFTAKHUL AKYUN | |
| 3 | PRAYOGI UNTARA | |
| 4 | MUTTAKIN | |
| 5 | KURNIAWATI | |
| 6 | SUHERMAN | |
| 7 | ANDI SULISTIA | |
| 8 | AGUS SETIAWAN | |
| 9 | SIYAMAH | |
| 10 | MUHYIDIN | |
| 11 | ASNAWI | |
| 12 | ISRO'I | |
| 13 | NGATIMIN | |
| 14 | SUKUR | |
| 15 | KARTONO | |
| 16 | SANDALI | |
| 17 | MUH JUHADI | |
| 18 | JUMADI | |
| 19 | MUHTASIRIN | |
| 20 | NURIDZATI | |
| 21 | SUROTO | |
| 22 | MUNTANDI | |
| 23 | SUBARI | |
| 24 | MUSTAKIMAH | |
| 25 | ZUBAEDI | |
| 26 | AKHMAD ZAEKHUN | |
| 27 | ISTANTO | |
| 28 | SITI ASIYAH | |
| 29 | TRIYANTO | |
| 30 | SUPRIYANTO | |
| 31 | ZAHRI |