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["長田善意銀行　払出申請書"]
["申請団体名",{"$nulls":6},"会員数",null,null,"人"]
["代表者名","　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　"]
["担当者名\n連　絡　先","担当者",{"$nulls":4},"連絡先"]
[null,"長田区",null,"　町・通　　　　",null,"丁目　　　　　",null,"番",null,"号"]
["助成申請額",{"$nulls":8},"円"]
["事 業 名"]
["事業内容","事業内容：(実施時期や場所、人数等を具体的に)"]
[]
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["総事業費","助成申請額根拠：",{"$nulls":4},"円"]
["内訳","収入",{"$nulls":4},"支出"]
[null,"善意銀行助成金",null,null,null,"円","消耗品費",null,null,null,"円"]
[null,"自己負担金",null,null,null,"円","会場費",null,null,null,"円"]
[null,"寄付金",null,null,null,"円","印刷費",null,null,null,"円"]
[{"$nulls":5},"円",{"$nulls":4},"円"]
[{"$nulls":5},"円",{"$nulls":4},"円"]
[null,"合計",null,null,null,"円","合計",null,null,null,"円"]
[null,"※収支はあわせてください。"]
["助　成　金\n振　込　先","（　　　　　　　　　　　　）　",null,"銀行・信用金庫・信用組合",null,null,null,"（　　　　　　　　　　　　）",null,"支店"]
[null,"普通　・　当座",null,"口座番号"]
[null,"ふりがな\n預金名義"]
["　　　年　　　月　　　日"]
[]
["社会福祉法人神戸市社会福祉協議会　長田区社会福祉協議会"]
["会長　山　下　淑　子　　様"]
[]
["上記のとおり、善意銀行助成金を交付いただきたく申請いたします。"]
["＜添付書類＞"]
[]
["　"]
["  "]
["※助成金交付決定後、下記書類の提出をお願いします。"]
["　①購入品、または事業時の写真※複数枚"]
["　②事業完了報告書と「ありがとうメッセージ」　◆決定通知とともに後日送付いたします。"]
["　　※レシート（領収書）コピーの提出は求めませんが、確認させていただく場合がありますので"]
["　　　保管をお願いいたします。"]

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["長田善意銀行　払出申請書"]
["申請団体名","○○の会",{"$nulls":5},"会員数",20,null,"人"]
["代表者名","　　　　　　　　　　　　　　　　　　　　　長田　太郎　　　　　　　　　　　　　　　　"]
["担当者名\n連　絡　先","担当者","長田　花子",null,null,null,"連絡先","078-123-456"]
[null,"長田区","北","　町・通　　　　",3,"丁目　　　　　",4,"番",3,"号"]
["助成申請額",30000,{"$nulls":7},"円"]
["助成の種類","次のいずれかをお選びください。"]
["事 業 名","地域交流コンサート"]
["事業内容","事業内容：(実施時期や場所、人数等を具体的に)"]
[null,"日時　20**年*月*日\n場所　〇〇地域福祉交流センター\n住民や障がい事業所、福祉施設の方々など、この地域に縁のある皆さんが、集まって親睦を深めることを目的とした交流コンサートを行います。"]
[]
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[null,"合計",null,50000,null,"円","合計",null,50000,null,"円"]
[null,"※収支はあわせてください。"]
["助　成　金\n振　込　先","（　　　〇〇　　　　）　",null,"銀行・信用金庫・信用組合",null,null,null,"（　　○○　　）",null,"支店"]
[null,"普通　・　当座",null,"口座番号",1234567]
[null,"ふりがな\n預金名義",null,"○○の会　代表　長田　太郎"]
["　20**年*月*日"]
[]
["社会福祉法人神戸市社会福祉協議会　長田区社会福祉協議会"]
["会長　山　下　淑　子　　様"]
[]
["上記のとおり、善意銀行助成金を交付いただきたく申請いたします。"]
["＜添付書類＞"]
[]
["　"]
["  "]
["※助成金交付決定後、下記書類の提出をお願いします。"]
["　①購入品、または事業時の写真※複数枚"]
["　②事業完了報告書と「ありがとうメッセージ」　◆決定通知とともに後日送付いたします。"]
["　　※レシート（領収書）コピーの提出は求めませんが、確認させていただく場合がありますので"]
["　　　保管をお願いいたします。"]