| No. | Nama | Paraf |
|---|---|---|
| 1 | SITI KHOLIFAH | |
| 2 | AHMAD RIZAL | |
| 3 | MUKHAFIDIN | |
| 4 | ROFIK ERSOFA | |
| 5 | MUKHOTIB | |
| 6 | ARIF ROCHMAN | |
| 7 | PUJIYATI | |
| 8 | SLAMET ADI | |
| 9 | WAHUDI | |
| 10 | PANDE | |
| 11 | NUR WAKHID | |
| 12 | RUKADI | |
| 13 | RAHAYU | |
| 14 | MUNJIYAT | |
| 15 | SAMSIR | |
| 16 | SURATINI | |
| 17 | SUWONO | |
| 18 | BAMBANG SUPRIHATIN | |
| 19 | WARIS | |
| 20 | DAMIRI | |
| 21 | MAHRIN | |
| 22 | MUSTAMIL | |
| 23 | MENTIK | |
| 24 | MURI | |
| 25 | SLAMET | |
| 26 | REBO | |
| 27 | JUWARI | |
| 28 | SUNARTO | |
| 29 | SUPARI | |
| 30 | KANIS | |
| 31 | TEMUHIRIN | |
| 32 | MATKUR | |
| 33 | SITI RUKOYAH | |
| 34 | SITI KOLIFAH | |
| 35 | SAHID | |
| 36 | ROKIB | |
| 37 | PARDIYANTO | |
| 38 | MUTASIRIN | |
| 39 | FATKHUL FIDIN | |
| 40 | SYARIF HIDAYAT | |
| 41 | WARSIDI | |
| 42 | MUHAMAD YUDI |