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["（別紙１　様式第６号　別添２　別記様式第１号）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請年月日",null,null,null,null,null,"年　　月　　日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　　　年度　　　第　　　号"]
["木の国協議会"]
["会長　岡田　和久　殿"]
["○○活動組織　　　　　"]
["代表　○○　○○　　"]
[]
["○○年○月○日付け○号にて採択通知のあった森林・山村多面的機能発揮対策交付金の交付を受けたいので、下記のとおり申請します。"]
[]
[]
["交  付  申  請 額","項目",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"金額"]
[null," 採択決定額　　　　　　　　　　　　①",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,"円"]
[null," 既交付額　　　　　　　　　　　　　②",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,"円"]
[null," 今回申請額　　　　　　　　　　　　③",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,"円"]
[null," 採択決定額（年間交付額）との差額  ④＝①－②－③",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"V13-V14-V15","v":0},null,null,null,null,null,null,null,null,"円"]
[]
["交  付  金  振  込  口  座"," 金融機関（ゆうちょ銀行以外）"]
[null," 金融機関名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," 支店名"]
[null,null,null,null,null,null,null,null,null,null," 農業協同組合　銀行　信用金庫"]
[null,null,null,null,null,null,null,null,null,null," 信用組合　労働金庫　信連　農林中金"]
[null,"預金種別（該当のものにレ印を記入）"]
[null,"□普通　□当座　　　　　　□別段　□通知",null,null,null,null,null,null,null,null,1,null,null,2,null,null,3,null,null,4,null,null,5,null,null,6,null,null,7]
[null," ≪ゆうちょ銀行の方はこちらに記入してください。≫"]
[null," ゆうちょ銀行"]
[null," 記号（６ケタ目がある場合は※部分に記入）",null,null,null,null,null,null,null,null,null,null,null,null,null," 番号（右づめで記入）"]
[null,1,null,2,null,3,null,4,null,5,null,"※",null,null,null,1,null,2,null,3,null,4,null,5,null,6,null,7,null,8]
[null," 店名",null,null,null,null,null,null,null,null,null,null,null,null,null," 店番"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,"店"]
[null,"預金種目（該当のものにレ印を記入）",null,null,null,null,null,null,null,null," 口座番号（右づめで記入）"]
[null,"□普通　□貯蓄　□当座"]
["口  座  名  義","フリガナ"]
[null,"口座名義"]
[null,"住所",null,null,null,"(〒      -          )           ",null,null,null,null,null,null,null,null,null,null,null,null,null,"都 道  府 県",null,null,null,null,null,null,null,"市 区  町 村"]
[null,null,null,null,null,"　　　　　　　　　　　　 　　            "]
[]
[]
["(注)交付金の振込口座の通帳の写し（口座番号、口座名義が分かる箇所）を添付してください。"]