| No. | Nama | Paraf |
|---|---|---|
| 1 | FAHRUDIN | |
| 2 | TRI SAFII | |
| 3 | YASIR | |
| 4 | TARSO | |
| 5 | MURYONO | |
| 6 | PURWANTO | |
| 7 | SUARTI | |
| 8 | KUKUH | |
| 9 | SIYAM | |
| 10 | SUATMAN | |
| 11 | NUNUNG TRIMAULAN | |
| 12 | WARISNO | |
| 13 | MIFTAHUDIN | |
| 14 | MUHAJIR | |
| 15 | AMIN ROHYAN | |
| 16 | SISWANTO | |
| 17 | TRI IKHSAN | |
| 18 | SUTARDI | |
| 19 | SUYARTO | |
| 20 | SUDARYO | |
| 21 | NUROHIM | |
| 22 | SISTORO | |
| 23 | MA'RUF FUAD HASAN | |
| 24 | YOGA TAMTOMO | |
| 25 | MUHSORI | |
| 26 | MISYONO | |
| 27 | MUHAMAD LUKMAN HAKIM | |
| 28 | SUPINAH | |
| 29 | GUSYANTO |