| No. | Nama | Paraf |
|---|---|---|
| 1 | GURIS ABD ROHMAN | |
| 2 | BUSARI | |
| 3 | SUWANTO | |
| 4 | MUSTOFA | |
| 5 | IMROAH | |
| 6 | ROHMAT | |
| 7 | SUMANTRI | |
| 8 | SAWAUN | |
| 9 | ROHMAN | |
| 10 | MANISO | |
| 11 | TRIMO | |
| 12 | SLAMET | |
| 13 | MISDI | |
| 14 | SALAMUN | |
| 15 | AMAT USUP | |
| 16 | SARWI | |
| 17 | SUBARI | |
| 18 | KABUL | |
| 19 | KUWADI | |
| 20 | SUWAR | |
| 21 | SURANI | |
| 22 | MUSLIMIN | |
| 23 | BAHRI | |
| 24 | MISRUN | |
| 25 | RAME | |
| 26 | NURKHAMID | |
| 27 | TOTOK SULISTIYO | |
| 28 | QODIR HASAN | |
| 29 | IMBUH | |
| 30 | MUDAH | |
| 31 | JUMARI | |
| 32 | FUAD ROIDAH | |
| 33 | ROHMAT |