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[]
[null,null,null,null,null,null,null,null,null,null,null,null,"受　付"]
["使　用　日　誌"]
[]
[]
[]
["使用年月日",null,"年",null,null,"月","日","時間","時",null,"分 ～",null,"時","分"]
[]
[]
[]
[]
["使用団体名",null,null,null,null,null,null,null,null,"人数",null,null,null,"人"]
[]
[]
[]
["請 求 書\n送 付 先",null,"住　所","〒"]
[]
[null,null,"氏　名",null,null,null,null,null,"電話"]
[]
[]
[null,"１階","　会議室　　",null,null,"　　調理実習室",null,"　集会室（和室44帖）",null,"　　第二会議室"]
["使 用 室 名"]
[null,null,"　　　　教養娯楽室（和室15帖）",null,null,null,null,"　機能回復訓練室",null,"　　その他"]
[]
[null,"２階"]
[null,null,"　　　大集会室",null,null,"　　視聴覚研修室",null,"　　 放送室","その他"]
[]
[]
[]
[" 冷 暖 房 使 用 の 有・無",null,null,null,null,null,null,"有","・","無"]
[null,null,null,null,null,"　　　　　　　（　　　　　　時　　　　　分 ～　　　　　時　　　　　分）"]
[]
[]
[]
[]
["使 用 器 具"]
[]
[]
[]
[]
["持  込  物"]
[]
[]
[]
[]
["使用後の点検",null,null,null,null,"ー確認のため　 印に必ずチェックしてくださいー"]
[]
[]
["◇使用後の掃除はお済みですか？",null,null,null,null,null,null,"はい","いいえ",null,"使ってない"]
[]
["◇冷暖房の切り忘れはないですか？",null,null,null,null,null,null,"はい","いいえ",null,"使ってない"]
[]
["◇ガスの元栓は閉めましたか？",null,null,null,null,null,null,"はい","いいえ",null,"使ってない"]
[]
["◇部屋の照明は消しましたか？",null,null,null,null,null,null,"はい","いいえ",null,"使ってない"]
[]
["◇破損した箇所はありませんか？",null,null,null,null,null,null,"はい","いいえ",null,"使ってない"]
[]
["　　○使用後は、昼間は事務室・夜間は事務室ポストへ提出してください。"]
[]
["　　ご利用ありがとうございました。気をつけてお帰りください。"]

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["申請書","・・・","１回利用ごとに１枚提出していただく"]
[null,null,"続けて何日利用されても各日で提出していただく"]
[]
["使用日誌","・・・","１回利用ごとに１枚提出していただく"]
[null,null,"続けて何日利用されても各日で提出していただく"]
[]
["調停","・・・","【施設使用料】地区公民館使用料の項目"]
[null,null,"【冷暖房使用料】公民館雑入の項目　　摘要に「冷暖房使用料」記載"]

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