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[null,"特別徴収申出書"]
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[{"$nulls":11},"特別徴収義務者","氏名又は名称",null,"㊞　　　",{"$nulls":12},"指定番号"]
[null,null,"増毛町長　　　様"]
[{"$nulls":27},"担当係"]
[null,null,null,"　　　　年　　　月　　　日",{"$nulls":8},"住所地",{"$nulls":14},"担当者氏名"]
[{"$nulls":8},"提　出"]
[{"$nulls":27},"電話番号",{"$nulls":4},"-",null,"-"]
[null,"　このことについて、次の者を当社（所）において特別徴収の方法により徴収しますので申出いたします。"]
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[null,"納　　　　　　税　　　　　　者",{"$nulls":15},"未　徴　収　額",{"$nulls":5},"徴 収 開 始 月",{"$nulls":5},"備　　　　　　考"]
[null,"氏　　名・生年月日",{"$nulls":5},"住　　　　　　　　所"]
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[{"$nulls":23},"令和　　　年　　　月分より"]
[null,"　　年　　　　月　　　　日　生"]
[{"$nulls":7},"〒",{"$nulls":14},"円",{"$nulls":6},"　年税額　　　　　　　　　　　　　円\n　納付済額　　　　　　　　　　 　円"]
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[null,"　　年　　　　月　　　　日　生"]
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[{"$nulls":23},"令和　　　年　　　月分より"]
[null,"　　年　　　　月　　　　日　生"]
[null,"※この申出書は当初普通徴収だった者を途中で特別徴収により徴収する場合、または事業所等で新たに特別徴収を始める場合のみ提出を必要とします。"]