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["様式第３号",null,null,null,null,null,null,null,null,null,null,null,null,null,"ふくやま芸術文化ホール　　　使用許可変更（取消）申請書"]
[null,null,"（公財）ふくやま芸術文化財団　理事長　様",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"受付",null,null,"    年  月  日",null,null,null,null,null,null,null,"第        号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"〒"]
[null,null,null,null,null,null,null,"申　請　者",null,null,null,null,null,"住　　所",null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"名　　前",null,null,null,null,null,""]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"代表者名",null,null,null,null,null," "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"電　　話",null,null,null,null,null,""]
[]
[null,null,null,null,null,"次のとおり、ふくやま芸術文化ホール　　を利用したいので、許可してください。"]
[" 行事等の名称",null,null,null,null,null,null,"　"]
[" 使用日時",null,null,null,null,"　　　　　年　　月　　日（　）　　　時から　　　　　年　　月　　日（　）　　　時まで　　　日間"]
["変更事項",null,null,null,null,"変　　　更　　　前",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"変　　　更　　　後"]
[]
[]
[]
[]
["変更\n   理由\n取消"]
[]
["使用料変更の有無",null,null,null,null,null,null,null,null,null,"無し"]
[" 使用施設",null,null,null,null,null,"日付",null,null,null,"区分",null,null,"開場",null,null,null,"開演",null,null,null,"終演",null,null,null,null," 使用施設",null,null,null,null,null,"日付",null,null,null,"区分",null,null,"開場",null,null,null,"開演",null,null,null,"終演"]
[]
[]
[]
[]
[]
[]
[]
[" 施設使用料",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null," 既納入額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[" 施設使用料(10円未満端数処理)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null," 追加納入額（△還付額）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[" 減　免　額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[" 納  入  額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null," 備付器具類等使用料金",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[" 残      額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,null," 総      計",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
["ふ　く　や　ま　芸　術　文　化　ホ　ー　ル"]
[" 主  　務",null,null,null,null," 管理課員",null,null,null,null,"管理担次長",null,null,null,null," 管理課長"]
[]
[]
[]
[null,null,null,null,null," 事業課員",null,null,null,null,"事業担次長",null,null,null,null," 事業課長"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"2016-福文-25 A4"]