{!! Form::text('awalan_surat',null,['class'=>'form-control','id'=>'nama_daerah']) !!}

{!! Form::text('urutan',null,['class'=>'form-control','id'=>'urutan']) !!}

{!! Form::text('kode_wilayah',null,['class'=>'form-control','id'=>'kode_wilayah']) !!}

{!! Form::number('tahun',null,['class'=>'form-control','id'=>'tahun']) !!}

{!! Form::select('daerah_id', $data, null,['class'=>'form-control','id'=>'daerah_id'], ['0' => 'pilih wilayah']) !!}