DISABILIT SUMBER

ID NKK NIK NAMA TEMPAT LAHIR TANGGAL LAHIR STATUS JK ALAMAT RT RW AS EKTP KET DATA TPS
DAFTAR PERUBAHAN PEMILIH UNTUK DPS
PEMILIHAN UMUM
TAHUN 2024
PROVINSI : -
KABUPATEN/KOTA : -
KECAMATAN : -
DESA/KELURAHAN : -

Pemilih Disabilitas STATUS KEPEMILIKAN KTP-EL HASIL COKLIT RINCIAN TMS

JUMLAH DATA BAHAN COKLIT
Nomor BAHAN DPS
No Urut (A-DAFTAR PEMILIH) 1. Disabilitas Fisik 2. Disabilitas Intelektual 3. Disabilitas Mental 4. Disabilitas Sensorik Wicara 5. Disabilitas Sensorik Rungu 6. Disabilitas Sensorik Netra Belum memiliki KTP-el Sudah memiliki KTP-el Data Sesuai Potensial Pemilih Ubah Elemen Data Pemilih TMS 1. Meninggal 2. Ganda 3. Dibawah umur 4. Pindah domisili 6. TNI 7. POLRI 8. Salah Penempatan TPS Status
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P L P L+P
1 2 3 4 5 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66
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114 114 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
115 115 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
116 116 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
117 117 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
118 118 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
119 119 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
120 120 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
121 121 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
122 122 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
123 123 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
124 124 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
125 125 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
126 126 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 129 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130 130 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
131 131 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
132 132 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
133 133 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
134 134 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
135 135 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
136 136 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
137 137 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
138 138 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
139 139 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
140 140 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
141 141 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
142 142 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
143 143 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
144 144 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
145 145 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
146 146 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
147 147 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
148 148 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
149 149 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
150 150 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
151 151 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
152 152 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
153 153 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
154 154 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
155 155 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
156 156 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
157 157 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
158 158 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
159 159 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
160 160 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
161 161 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
162 162 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
163 163 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
164 164 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
165 165 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
166 166 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
167 167 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
168 168 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
169 169 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
170 170 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas batas
 DAFTAR PERUBAHAN PEMILIH UNTUK DPS
MODEL A-Daftar Perubahan Pemilih
PEMILIHAN UMUM
TAHUN 2024

PROVINSI : KECAMATAN   :
KABUPATEN/KOTA : DESA/KELURAHAN :
TPS :

Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 3 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 4 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 5 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 6 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 7 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 8 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 9 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 10 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 11 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 12 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Hlm. 13 dari 27
 Status Status
Jenis Alamat
Perkawin Disabilit Kepemilik Keterang
No No. KK NIK Nama Tempat Lahir Tanggal Lahir Kelamin
an as an KTP-el an *)
L/P
B/S/P Jalan/Dukuh RT RW S/B
1 2 3 4 5 6 7 8 9 10 11 12 13 14

Keterangan Status Perkawinan (7) : Keterangan Disabilitas (12): Keterangan Status: Kepemilikan KTP-el (13): *) Keterangan (14):
B : Belum Kawin 1: Disabilitas Fisik B : Belum memiliki KTP-el B : Baru 6 : TNI
S : Kawin 2: Disabilitas Intelektual S : Sudah memiliki KTP-el U : Ubah elemen data 7 : Polri
P : Pernah Kawin 3: Disabilitas Mental 1 : Meninggal 8 : Salah Penempatan TPS
4: Disabilitas Sensorik Wicara 2 : Ganda
5: Disabilitas Sensorik Rungu 3 : Dibawah Umur
6: Disabilitas Sensorik Netra 4 : Pindah Domisili

Hlm. 14 dari 27
 MODEL A-Rekap PPS Perubahan Pemilih

REKAPITULASI PERUBAHAN PEMILIH UNTUK DPS

PEMILIHAN UMUM
TAHUN 2024
OLEH PPS

PROVINSI :0 KECAMATAN : 0
KABUPATEN/KOTA :0 KELURAHAN/DESA : 0

Jumlah Pemilih Jumlah Pemilih

Jumlah Pemilih Jumlah Pemilih Jumlah Perbaikan
NO Nomor TPS Tidak Memenuhi Potensial Non KTP-
Aktif Baru Data Pemilih
Syarat el
1 001 - - - - -
2 002 - - - - -
3 003 - - - - -
4 004 - - - - -
5 005 - - - - -
6 006 - - - - -
7 007 - - - - -
8 008 - - - - -
9 009 - - - - -
10 010 - - - - -
11 011 - - - - -
12 012 - - - - -
13 013 - - - - -
14 014 - - - - -
15 015 - - - - -
16 016 - - - - -
17 017 - - - - -
18 018 - - - - -
19 019 - - - - -
20 020 - - - - -
21 021 - - - - -
22 022 - - - - -
23 023 - - - - -
24 024 - - - - -
25 025 - - - - -
26 026 - - - - -
27 027 - - - - -
28 028 - - - - -
29 029 - - - - -
30 030 - - - - -
31 031 - - - - -
32 032 - - - - -
33 033 - - - - -
34 034 - - - - -
35 035 - - - - -
36 036 - - - - -
37 037 - - - - -
38 038 - - - - -
39 039 - - - - -
40 040 - - - - -
41 041 - - - - -
42 042 - - - - -
43 043 - - - - -
44 044 - - - - -
45 045 - - - - -
 PROVINSI :0 KECAMATAN : 0
KABUPATEN/KOTA :0 KELURAHAN/DESA : 0

Jumlah Pemilih Jumlah Pemilih

Jumlah Pemilih Jumlah Pemilih Jumlah Perbaikan
NO Nomor TPS Tidak Memenuhi Potensial Non KTP-
Aktif Baru Data Pemilih
Syarat el
46 046 - - - - -
47 047 - - - - -
48 048 - - - - -
49 049 - - - - -
50 050 - - - - -
51 051 - - - - -
52 052 - - - - -
53 053 - - - - -
54 054 - - - - -
55 055 - - - - -
56 056 - - - - -
57 057 - - - - -
58 058 - - - - -
59 059 - - - - -
60 060 - - - - -
61 061 - - - - -
62 062 - - - - -
63 063 - - - - -
64 064 - - - - -
65 065 - - - - -
66 066 - - - - -
67 067 - - - - -
68 068 - - - - -
69 069 - - - - -
70 070 - - - - -
71 071 - - - - -
72 072 - - - - -
73 073 - - - - -
74 074 - - - - -
75 075 - - - - -
76 076 - - - - -
77 077 - - - - -
78 078 - - - - -
79 079 - - - - -
80 080 - - - - -
81 081 - - - - -
82 082 - - - - -
83 083 - - - - -
84 084 - - - - -
85 085 - - - - -
86 086 - - - - -
87 087 - - - - -
88 088 - - - - -
89 089 - - - - -
90 090 - - - - -
91 091 - - - - -
92 092 - - - - -
93 093 - - - - -
94 094 - - - - -
95 095 - - - - -
96 096 - - - - -
 PROVINSI :0 KECAMATAN : 0
KABUPATEN/KOTA :0 KELURAHAN/DESA : 0

Jumlah Pemilih Jumlah Pemilih

Jumlah Pemilih Jumlah Pemilih Jumlah Perbaikan
NO Nomor TPS Tidak Memenuhi Potensial Non KTP-
Aktif Baru Data Pemilih
Syarat el
97 097 - - - - -
98 098 - - - - -
99 099 - - - - -
100 100 - - - - -
101 101 - - - - -
102 102 - - - - -
103 103 - - - - -
104 104 - - - - -
105 105 - - - - -
106 106 - - - - -
107 107 - - - - -
108 108 - - - - -
109 109 - - - - -
110 110 - - - - -
111 111 - - - - -
112 112 - - - - -
113 113 - - - - -
114 114 - - - - -
115 115 - - - - -
116 116 - - - - -
117 117 - - - - -
118 118 - - - - -
119 119 - - - - -
120 120 - - - - -
121 121 - - - - -
122 122 - - - - -
123 123 - - - - -
124 124 - - - - -
125 125 - - - - -
126 126 - - - - -
127 127 - - - - -
128 128 - - - - -
129 129 - - - - -
130 130 - - - - -
131 131 - - - - -
132 132 - - - - -
133 133 - - - - -
134 134 - - - - -
135 135 - - - - -
136 136 - - - - -
137 137 - - - - -
138 138 - - - - -
139 139 - - - - -
140 140 - - - - -
141 141 - - - - -
142 142 - - - - -
143 143 - - - - -
144 144 - - - - -
145 145 - - - - -
146 146 - - - - -
147 147 - - - - -
 PROVINSI :0 KECAMATAN : 0
KABUPATEN/KOTA :0 KELURAHAN/DESA : 0

Jumlah Pemilih Jumlah Pemilih

Jumlah Pemilih Jumlah Pemilih Jumlah Perbaikan
NO Nomor TPS Tidak Memenuhi Potensial Non KTP-
Aktif Baru Data Pemilih
Syarat el
148 148 - - - - -
149 149 - - - - -
150 150 - - - - -
151 151 - - - - -
152 152 - - - - -
153 153 - - - - -
154 154 - - - - -
155 155 - - - - -
156 156 - - - - -
157 157 - - - - -
158 158 - - - - -
159 159 - - - - -
160 160 - - - - -
161 161 - - - - -
162 162 - - - - -
163 163 - - - - -
164 164 - - - - -
165 165 - - - - -
166 166 - - - - -
167 167 - - - - -
168 168 - - - - -
169 169 - - - - -
170 170 - - - - -
TOTAL - - - - -

Disahkan dalam rapat pleno PPS di …............................. Tanggal …....................................

PANITIA PEMUNGUTAN SUARA

1. …............................................... Ketua 1. …............................

2. …............................................... Anggota 2. …............................

3. …............................................... Anggota 3. …............................

 MODEL A-Rekap PPS Perubahan Pemilih
REKAPITULASI PERUBAHAN PEMILIH UNTUK DPS
PEMILIHAN UMUM
TAHUN 2024
OLEH PPS

PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
1 001 - - - - - - - - - - - - - - -
2 002 - - - - - - - - - - - - - - -
3 003 - - - - - - - - - - - - - - -
4 004 - - - - - - - - - - - - - - -
5 005 - - - - - - - - - - - - - - -
6 006 - - - - - - - - - - - - - - -
7 007 - - - - - - - - - - - - - - -
8 008 - - - - - - - - - - - - - - -
9 009 - - - - - - - - - - - - - - -
10 010 - - - - - - - - - - - - - - -
11 011 - - - - - - - - - - - - - - -
12 012 - - - - - - - - - - - - - - -
13 013 - - - - - - - - - - - - - - -
14 014 - - - - - - - - - - - - - - -
15 015 - - - - - - - - - - - - - - -
16 016 - - - - - - - - - - - - - - -
17 017 - - - - - - - - - - - - - - -
18 018 - - - - - - - - - - - - - - -
19 019 - - - - - - - - - - - - - - -
20 020 - - - - - - - - - - - - - - -
21 021 - - - - - - - - - - - - - - -
22 022 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
23 023 - - - - - - - - - - - - - - -
24 024 - - - - - - - - - - - - - - -
25 025 - - - - - - - - - - - - - - -
26 026 - - - - - - - - - - - - - - -
27 027 - - - - - - - - - - - - - - -
28 028 - - - - - - - - - - - - - - -
29 029 - - - - - - - - - - - - - - -
30 030 - - - - - - - - - - - - - - -
31 031 - - - - - - - - - - - - - - -
32 032 - - - - - - - - - - - - - - -
33 033 - - - - - - - - - - - - - - -
34 034 - - - - - - - - - - - - - - -
35 035 - - - - - - - - - - - - - - -
36 036 - - - - - - - - - - - - - - -
37 037 - - - - - - - - - - - - - - -
38 038 - - - - - - - - - - - - - - -
39 039 - - - - - - - - - - - - - - -
40 040 - - - - - - - - - - - - - - -
41 041 - - - - - - - - - - - - - - -
42 042 - - - - - - - - - - - - - - -
43 043 - - - - - - - - - - - - - - -
44 044 - - - - - - - - - - - - - - -
45 045 - - - - - - - - - - - - - - -
46 046 - - - - - - - - - - - - - - -
47 047 - - - - - - - - - - - - - - -
48 048 - - - - - - - - - - - - - - -
49 049 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
50 050 - - - - - - - - - - - - - - -
51 051 - - - - - - - - - - - - - - -
52 052 - - - - - - - - - - - - - - -
53 053 - - - - - - - - - - - - - - -
54 054 - - - - - - - - - - - - - - -
55 055 - - - - - - - - - - - - - - -
56 056 - - - - - - - - - - - - - - -
57 057 - - - - - - - - - - - - - - -
58 058 - - - - - - - - - - - - - - -
59 059 - - - - - - - - - - - - - - -
60 060 - - - - - - - - - - - - - - -
61 061 - - - - - - - - - - - - - - -
62 062 - - - - - - - - - - - - - - -
63 063 - - - - - - - - - - - - - - -
64 064 - - - - - - - - - - - - - - -
65 065 - - - - - - - - - - - - - - -
66 066 - - - - - - - - - - - - - - -
67 067 - - - - - - - - - - - - - - -
68 068 - - - - - - - - - - - - - - -
69 069 - - - - - - - - - - - - - - -
70 070 - - - - - - - - - - - - - - -
71 071 - - - - - - - - - - - - - - -
72 072 - - - - - - - - - - - - - - -
73 073 - - - - - - - - - - - - - - -
74 074 - - - - - - - - - - - - - - -
75 075 - - - - - - - - - - - - - - -
76 076 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
77 077 - - - - - - - - - - - - - - -
78 078 - - - - - - - - - - - - - - -
79 079 - - - - - - - - - - - - - - -
80 080 - - - - - - - - - - - - - - -
81 081 - - - - - - - - - - - - - - -
82 082 - - - - - - - - - - - - - - -
83 083 - - - - - - - - - - - - - - -
84 084 - - - - - - - - - - - - - - -
85 085 - - - - - - - - - - - - - - -
86 086 - - - - - - - - - - - - - - -
87 087 - - - - - - - - - - - - - - -
88 088 - - - - - - - - - - - - - - -
89 089 - - - - - - - - - - - - - - -
90 090 - - - - - - - - - - - - - - -
91 091 - - - - - - - - - - - - - - -
92 092 - - - - - - - - - - - - - - -
93 093 - - - - - - - - - - - - - - -
94 094 - - - - - - - - - - - - - - -
95 095 - - - - - - - - - - - - - - -
96 096 - - - - - - - - - - - - - - -
97 097 - - - - - - - - - - - - - - -
98 098 - - - - - - - - - - - - - - -
99 099 - - - - - - - - - - - - - - -
100 100 - - - - - - - - - - - - - - -
101 101 - - - - - - - - - - - - - - -
102 102 - - - - - - - - - - - - - - -
103 103 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
104 104 - - - - - - - - - - - - - - -
105 105 - - - - - - - - - - - - - - -
106 106 - - - - - - - - - - - - - - -
107 107 - - - - - - - - - - - - - - -
108 108 - - - - - - - - - - - - - - -
109 109 - - - - - - - - - - - - - - -
110 110 - - - - - - - - - - - - - - -
111 111 - - - - - - - - - - - - - - -
112 112 - - - - - - - - - - - - - - -
113 113 - - - - - - - - - - - - - - -
114 114 - - - - - - - - - - - - - - -
115 115 - - - - - - - - - - - - - - -
116 116 - - - - - - - - - - - - - - -
117 117 - - - - - - - - - - - - - - -
118 118 - - - - - - - - - - - - - - -
119 119 - - - - - - - - - - - - - - -
120 120 - - - - - - - - - - - - - - -
121 121 - - - - - - - - - - - - - - -
122 122 - - - - - - - - - - - - - - -
123 123 - - - - - - - - - - - - - - -
124 124 - - - - - - - - - - - - - - -
125 125 - - - - - - - - - - - - - - -
126 126 - - - - - - - - - - - - - - -
127 127 - - - - - - - - - - - - - - -
128 128 - - - - - - - - - - - - - - -
129 129 - - - - - - - - - - - - - - -
130 130 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
131 131 - - - - - - - - - - - - - - -
132 132 - - - - - - - - - - - - - - -
133 133 - - - - - - - - - - - - - - -
134 134 - - - - - - - - - - - - - - -
135 135 - - - - - - - - - - - - - - -
136 136 - - - - - - - - - - - - - - -
137 137 - - - - - - - - - - - - - - -
138 138 - - - - - - - - - - - - - - -
139 139 - - - - - - - - - - - - - - -
140 140 - - - - - - - - - - - - - - -
141 141 - - - - - - - - - - - - - - -
142 142 - - - - - - - - - - - - - - -
143 143 - - - - - - - - - - - - - - -
144 144 - - - - - - - - - - - - - - -
145 145 - - - - - - - - - - - - - - -
146 146 - - - - - - - - - - - - - - -
147 147 - - - - - - - - - - - - - - -
148 148 - - - - - - - - - - - - - - -
149 149 - - - - - - - - - - - - - - -
150 150 - - - - - - - - - - - - - - -
151 151 - - - - - - - - - - - - - - -
152 152 - - - - - - - - - - - - - - -
153 153 - - - - - - - - - - - - - - -
154 154 - - - - - - - - - - - - - - -
155 155 - - - - - - - - - - - - - - -
156 156 - - - - - - - - - - - - - - -
157 157 - - - - - - - - - - - - - - -
 PROVINSI :0 KECAMATAN :0
KABUPATEN/KOTA : 0 KELURAHAN/DESA :0

Jumlah Pemilih Tidak Jumlah Perbaikan Jumlah Pemilih Potensial

Nomor Jumlah Pemilih Aktif Jumlah Pemilih Baru
NO Memenuhi Syarat Data Pemilih Non KTP-El
TPS
L P L+P L P L+P L P L+P L P L+P L P L+P
158 158 - - - - - - - - - - - - - - -
159 159 - - - - - - - - - - - - - - -
160 160 - - - - - - - - - - - - - - -
161 161 - - - - - - - - - - - - - - -
162 162 - - - - - - - - - - - - - - -
163 163 - - - - - - - - - - - - - - -
164 164 - - - - - - - - - - - - - - -
165 165 - - - - - - - - - - - - - - -
166 166 - - - - - - - - - - - - - - -
167 167 - - - - - - - - - - - - - - -
168 168 - - - - - - - - - - - - - - -
169 169 - - - - - - - - - - - - - - -
170 170 - - - - - - - - - - - - - - -
TOTAL - - - - - - - - - - - - - - -

Disahkan dalam rapat pleno PPS di …............................. Tanggal …....................................

PANITIA PEMUNGUTAN SUARA

1. …............................................... Ketua 1. …............................

2. …............................................... Anggota 2. …............................

3. …............................................... Anggota 3. …............................

 BERITA ACARA
Nomor: …......................................................

REKAPITULASI DAFTAR PERUBAHAN PEMILIH HASIL PEMUTAKHIRAN

TINGKAT KELURAHAN/DESA ………………….
PEMILIHAN UMUM TAHUN 2024

Pada hari ini ………… tanggal …………… bulan …………... tahun Dua Ribu Dua Puluh Tiga
bertempat di ………………, PPS …………. telah melaksanakan Rapat Pleno Terbuka Rekapitulasi Daftar
Perubahan Pemilih Hasil Pemutakhiran Tingkat Kelurahan/Desa …………... untuk Pemilihan Umum
Tahun 2024.
Dalam Rapat tersebut, PPS …………... menetapkan Rekapitulasi Daftar Perubahan Pemilih
Hasil Pemutakhiran Kelurahan/Desa …………… dengan rincian sebagai berikut:

1. Rekapitulasi Daftar Perubahan Pemilih Hasil Pemutakhiran

REKAPITULASI DAFTAR PERUBAHAN PEMILIH HASIL PEMUTAKHIRAN
KELURAHAN/DESA …………………….

PEMILIH
JUMLAH PEMILIH TIDAK PERBAIKAN
PEMILIH AKTIF PEMILIH BARU POTENSIAL
TPS MEMENUHI SYARAT DATA PEMILIH NON KTP-el

170 0 0 0 0 0

2. Menerima masukan data dari:

a. -
b. -
Rekapitulasi Daftar Perubahan Pemilih Hasil Pemutakhiran tersebut selanjutnya ditetapkan
secara lebih rinci dalam dokumen Rekapitulasi tingkat Kelurahan/Desa ……... sebagaimana terlampir
yang merupakan bagian tidak terpisahkan dari Berita Acara ini.

Demikian Berita Acara ini dibuat untuk dipergunakan sebagaimana mestinya.

Dibuat di : ….................................
Pada tanggal : ….................................

PPS …............................................

1. …............................................... Ketua 1. …............................

2. …............................................... Anggota 2. …............................

3. …............................................... Anggota 3. …............................