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[]
[null,"別記様式第1号　（第3条関係）"]
[]
[null,"青木村田舎暮らし体験住宅借用申請書"]
[]
[{"$nulls":8},"年　　　月　　　日　"]
[]
[null,"青木村長　　　　　　様"]
[]
[{"$nulls":5},"申請者","住所"]
[{"$nulls":6},"氏名",null,null,"　印　"]
[]
[null,"　青木村田舎暮らし体験住宅を借用したいので、青木村田舎暮らし体験事業実施要綱第3条の規定により、次のとおり申請いたします。"]
[]
[]
[null,"借受者",null,"氏　名",null,"年齢","職業",null,"申請者との続柄"]
[]
[]
[]
[]
[]
[null,"現住所",null,"　〒"]
[null,"電話番号",null,"　（自宅）"]
[null,null,null,"　（携帯）"]
[null,"メールアドレス"]
[null,"自動車の有無",null,"　　　有　・　無　　　（　自家用車・レンタカー・その他　　　　　　　　　）"]
[null,"借用期間",null,"年　　月　　日　（　　）　午前・午後　　　時　　分　から"]
[null,null,null,"年　　月　　日　（　　）　午前・午後　　　時　　分　まで"]
[null,"体験住宅を借用したい目的"]
[null,"その他（ご要望、ご質問などがございましたらご記入ください。）"]
[]
[null,"※　現住所の分かる、写真付き公的身分証明の写しを添付してください。"]
[null,"※　申請者の氏名が自署の場合は押印を省略できます。"]