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["別記第1号様式(第3条関係)"]
[]
["函館市恵山コミュニティセンター使用許可申請書"]
[]
["年　　月　　日　"]
[]
[]
["　恵山地区町会連合会長　様"]
[]
[]
[null,"住所"]
["申請者","氏名"]
[]
["電話　　　　　　局　　　　　　番　　　"]
[]
[]
["　次のとおり函館市恵山コミュニティセンターを使用したいので申請します。"]
["使用目的"]
["商品の宣伝，展示，販売等営利目的または入場料等の徴収の有無",null,null,null,null,"有・無"]
["使用区分","使用年月日",null,"使用場所","時間区分",null,"使用人数"]
[null,"年　　月　　日",null,null,"午前・午後・夜間・全日",null,"人"]
[null,"年　　月　　日",null,null,"午前・午後・夜間・全日",null,"人"]
[null,"年　　月　　日",null,null,"午前・午後・夜間・全日",null,"人"]
[null,"年　　月　　日",null,null,"午前・午後・夜間・全日",null,"人"]
["※使用料",null,null,"円(うち暖房料　　　　　円)　　"]
[]
["注　1　商品の宣伝，展示，販売等営利目的または入場料等の徴収の有無欄および時間区分欄は，該当するものを○で囲んでください。"]
["　　2　※印欄は，記入しないでください。"]