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{"sheet":"収入申告書","index":0,"n_rows":66,"n_cols":24,"rows_kept":66,"cut":false,"hidden":false,"merged":[[54,1,55,3],[56,1,57,3],[50,20,53,23],[50,1,51,3],[50,4,51,9],[50,10,51,14],[50,15,51,19],[52,1,53,3],[3,1,13,1],[2,13,7,13],[8,13,13,13],[2,1,2,11],[10,2,11,2],[8,2,9,2],[3,2,6,2],[12,2,13,3],[10,3,11,11],[12,4,13,4],[12,5,13,5],[12,6,13,6],[12,7,13,7],[12,8,13,8],[12,9,13,9],[12,10,13,10],[12,11,13,11],[2,14,2,15],[3,14,5,15],[6,14,7,15],[8,14,8,15],[9,14,11,15],[12,14,13,15],[6,22,7,22],[6,23,7,23],[12,16,13,16],[12,17,13,17],[12,18,13,18],[12,19,13,19],[12,20,13,20],[12,21,13,21],[12,22,13,22],[6,20,7,20],[6,16,7,16],[6,17,7,17],[6,18,7,18],[6,19,7,19],[6,21,7,21],[23,1,24,3],[17,4,18,9],[17,10,18,14],[17,15,18,18],[17,19,18,23],[33,19,34,23],[35,19,36,23],[0,1,0,23],[29,1,30,3],[31,1,32,3],[33,1,34,3],[35,1,36,3],[29,4,30,9],[29,10,30,14],[29,15,30,18],[29,19,30,23],[31,19,32,23],[12,23,13,23],[17,1,18,3],[19,1,20,3],[21,1,22,3]]}
[null,"収入申告書"]
[null,"太枠内のみご記入ください。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"令和　　年　　月　　日"]
[null,"主たる生計維持者（世帯主）",null,null,null,null,null,null,null,null,null,null,null,"(イ)","フリガナ"]
[null,"(ア)","住所",null,null,null,null,null,null,null,null,null,null,null,"被保険者氏名"]
[]
[]
[null,null,null,null,"電話番号",null,null,null,null,null,null,null,null,null,"被保険者番号"]
[null,null,"フリガナ"]
[null,null,"氏名",null,null,null,null,null,null,null,null,null,null,"(ウ)","フリガナ"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"被保険者氏名"]
[null,null,"生年月日","明治・大正・昭和・平成　　　年　　月　　日"]
[]
[null,null,"被保険者番号",null,null,null,null,null,null,null,null,null,null,null,"被保険者番号"]
[]
[null,"※世帯主が被保険者の場合、被保険者番号を記入してください。"]
[]
[null,"１　主たる生計維持者の減少見込の収入について（減少が見込まれる収入が複数ある時はそれぞれ記入してください。）"]
[null,"収入の種類",null,null,"令和元年中の収入額\n(実績）①",null,null,null,null,null,"令和2年中の収入見込額②",null,null,null,null,"控除額③",null,null,null,"減少率\n（①-②-③）/①"]
[]
[]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[null,"※対象となる収入の種類は、給与収入、事業収入、不動産収入、山林収入です。"]
[null,"※控除額とは、対象の収入減少に対して受け取った保険金及び損害賠償等補填される金額です。"]
[]
[null,"２　主たる生計維持者の令和2年中の収入見込状況について"]
[null,"収入の種類",null,null,"申請時までの収入実績額",null,null,null,null,null,"申請時以後の収入見込額",null,null,null,null,"令和2年中の収入見込額(実績＋見込）　②へ",null,null,null,"事業の廃止・失業"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"廃止・失業"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"廃止・失業"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"廃止・失業"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[null,"（収入見込額の算出方法等を記載してください）"]
[]
[]
[]
[]
[]
[]
[]
[null,"※対象となる収入の種類は、給与収入、事業収入、不動産収入、山林収入です。"]
[null,"※収入状況が確認できる書類を添付してください。"]
[null,"※事業の廃止・失業の場合は、それぞれ確認できる書類を添付してください。"]
[]
[null,"３　主たる生計維持者及び世帯の全被保険者の令和元年中の所得について(基礎控除や各種控除を適用する前の額）"]
[null,null,null,null,"主たる生計維持者(世帯主）（ア）",null,null,null,null,null,"被保険者(イ)",null,null,null,null,"被保険者(ウ)",null,null,null,null,"合計額"]
[]
[null,"年金所得"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,null,"円"]
[null,"給与所得"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,null,"円"]
[null,"その他所得"]
[null,null,null,null,null,null,null,null,null,"円",null,null,null,null,"円",null,null,null,null,"円",null,null,null,"円"]
[]
[null,"【誓約・同意事項】     ※誓約・同意事項をよく読んで、署名押印してください。"]
[null,"・","決定要件の妥当性を審査するため、広域連合が必要な所得・課税情報等の確認を行うことや必要な資料を他の行政"]
[null,null,"機関等に求めることを同意します。"]
[null,"・","収入及び所得の状況については収入申告書に記載のとおりです。なお、事実と異なる内容であることが判明した場"]
[null,null,"合は、減免額の変更または減免の取消をされても異議はありません。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請者の署名",null,null,null,null,null,null,null,"印"]