BERITA ACARA

MUSYAWARAH PERENCANAAN PEMBANGUNAN DESA

MUSRENBANG DESA RKP DESA TAHUN 20...

Berkaitan dengan pelaksanaan kegiatan pembahasan dan penyepakatan skala prioritas

pembangunan Desa tahun Anggaran 20..., di Desa ……… Kecamatan ........ Kabupaten Situbondo
Provinsi Jawa Timur dalam rangka Penyusunan RKP Desa Tahun 20..., maka pada hari ini:

Hari dan Tanggal : ..............., .................. 20...

Jam : .............................................
Tempat : .............................................

telah diadakan kegiatan kegiatan musyawarah perencanaan pembangunan Desa (musrenbang

Desa), yang telah dihadiri oleh wakil-wakil dusun/kelompok (delegasi) dan tokoh masyarakat, serta
unsur lain yang terkait Desa sebagaimana tercantum dalam daftar hadir terlampir.

Materi yang dibahas, serta yang bertindak selaku unsur pimpinan rapat dan narasumber dalam
membahas kegiatan musrenbang Desa adalah:

A. Materi
1. Pembahasan Rancangan RKP Desa Tahun 20...;
2. Pemeringkatan prioritas kegiatan perbidang; dan
3. Penyepakatan Rancangan RKP Desa Tahun 20....

B. Unsur Pimpinan Rapat dan Narasumber

Pemimpin Musyawarah : ........................................................... dari .............
Notulen : ........................................................... dari .............
Narasumber : 1. ........................................................ dari .............
2. ........................................................ dari .............
3. ........................................................ dari .............
4. ........................................................ dari .............
5. ......dan seterusnya. dari .............

Unsur Peserta : 1. ........................................................ dari .............

2. ........................................................ dari .............
3. ......dan seterusnya. dari .............

Setelah dilakukan pembahasan dan diskusi terhadap materi, selanjutnya seluruh peserta musyawarah
menyepakati beberapa hal yang berketetapan menjadi kesepakatan akhir dari musyawarah
perencanaan pembangunan Desa yaitu:
..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................
..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

..........................................................................................................................................................

Keputusan diambil secara musyawarah mufakat/aklamasi dan pemungutan suara/voting.

Demikian Berita Acara ini dibuat dan disahkan dengan penuh tanggungjawab agar dapat dipergunakan
sebagaimana mestinya.

....nama desa, ..... - ..... - 20...

Ketua BPD, Kepala Desa,

Nama, tanda tangan & cap Nama, tanda tangan & cap
.......................................... ..........................................

Wakil Masyarakat

…………………………………
 NOTULENSI

Agenda Kegiatan : Musrenbang Desa RKP Desa Tahun 20...

Hari dan Tanggal : ................, ...........................20...

Jam : ......................................................

Notulen:
........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................
........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

........................................................................................................................................................

....nama desa, ..... - ..... - 20...

Notulis,

................................................
 DAFTAR HADIR
MUSYAWARAH PERENCANAAN PEMBANGUNAN DESA
(MUSRENBANG DESA)
PENYUSUNAN RKP DESA TAHUN 20...

Hari/Tanggal : ............., ....................... 20...

Jam : .................... WIB
Tempat : ................................................
Jumlah Peserta : .............. orang
Laki-laki : ................ orang, Perempuan : ................ orang
JABATAN/ TANDA
NO NAMA L/P ALAMAT
UNSUR TANGAN
1. 1.

2. 2.

3. 3.

4. 4.

5. 5.

6. 6.

7. 7.

8. 8.

9. 9.

10. 10.

11. 11.

12. 12.

13. 13.

14. 14.

15. 15.

16. 16.

17. 17.

18. 18.

19. 19.

20. 20.

21. 21.

22. 22.

23. 23.

24. 24.

25. 25.
 JABATAN/ TANDA
NO NAMA L/P ALAMAT
UNSUR TANGAN
26. 26.

27. 27.

28. 28.

29. 29.

30. 30.

31. 31.

32. 32.

33. 33.

34. 34.

35. 35.

36. 36.

37. 37.

38. 38.

39. 39.

40. 40.

41. 41.

42. 42.

43. 43.

44. 44.

45. 45.

46. 46.

47. 47.

48. 48.

49. 49.

50. 50.

....nama desa, ..... - ..... - 20...

Ketua BPD, Kepala Desa,

Nama, tanda tangan & cap Nama, tanda tangan & cap
.......................................... ..........................................