| NO | NAMA LENGKAP | ALAMAT | RW | RT | TEMPAT ASAL | MASA BERLAKU |
|---|---|---|---|---|---|---|
| 1 | NURUL HUDA | HANGTUAH 2/6-A | 009 | 001 | GRESIK | 26-11-2014 |
| 2 | SUBAIRI | HANGTUAH 5/11 | 009 | 003 | SAMPANG | 13-11-2014 |
| 3 | I D A | HANGTUAH 5/11 | 009 | 003 | SAMPANG | 13-11-2014 |
| 4 | SUMIATI | SAWAH PULO WETAN 5/9 | 012 | 009 | SAMPANG | 21-02-2015 |
| 5 | MOCH HASYIM | JATIPURWO 5/4 | 013 | 003 | BANGKALAN | 24-02-2015 |
| 6 | MURSIDI | JATIPURWO 3/1 | 013 | 006 | BANGKALAN | 17-09-2015 |
| 7 | ASISEH | JATIPURWO 3/1 | 013 | 006 | BANGKALAN | 17-09-2015 |