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  </td>
  <td width=3D307 style=3D'width:184.05pt;border:solid windowtext 1.0pt;bor=
der-left:
  none;mso-border-left-alt:solid windowtext .75pt;mso-border-alt:solid wind=
owtext .75pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:14.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#26085;<span lang=3DEN-US><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></=
span>&#31243;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D268 style=3D'width:161.0pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .75pt;mso-border-alt:solid wind=
owtext .75pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:14.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#20633;<span lang=3DEN-US><span
  style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp; </span></span>&#32771=
;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D134 style=3D'width:80.4pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .75pt;mso-border-alt:solid windo=
wtext .75pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#22899;&#23376;&#65315;&#32026;<span lang=3DEN-US><o=
:p></o:p></span></span></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#65408;&#65438;&#65420;&#65438;&#65433;&#65405;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D84 style=3D'width:50.55pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .75pt;mso-border-left-alt:solid windo=
wtext .75pt;
  mso-border-alt:solid windowtext .75pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothi=
c";
  color:#333333;font-weight:normal'>32</span><span style=3D'font-size:14.0p=
t;
  font-family:"MS PGothic";color:#333333;font-weight:normal'>&#32068;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D307 style=3D'width:184.05pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .75pt;mso-border-left-alt:solid windo=
wtext .75pt;
  mso-border-alt:solid windowtext .75pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#65297;&#65296;&#26376;&#65298;&#65300;&#26085;<span
  lang=3DEN-US>(</span>&#26376;<span lang=3DEN-US>)<o:p></o:p></span></span=
></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#12522;&#12540;&#12464;&#25126;&#65374;&#27770;&#212=
13;&#65412;&#65392;&#65413;&#65426;&#65437;&#65412;&#25126;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D268 rowspan=3D2 style=3D'width:161.0pt;border-top:none;border=
-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .75pt;mso-border-left-alt:solid windo=
wtext .75pt;
  mso-border-alt:solid windowtext .75pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'margin-left:8.0pt;text-indent:-8.0pt;mso-ch=
ar-indent-count:
  -.57;mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span
  style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333333;font-wei=
ght:
  normal'>&#35430;&#21512;&#38283;&#22987;&#65305;&#65306;&#65296;&#65296;&=
#65374;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoNormal style=3D'margin-left:8.0pt;text-indent:-8.0pt;mso-ch=
ar-indent-count:
  -.57;mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span lang=3D=
EN-US
  style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333333;font-wei=
ght:
  normal'><o:p>&nbsp;</o:p></span></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#20104;&#20633;&#26085;&#65306;<span lang=3DEN-US><o=
:p></o:p></span></span></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothi=
c";
  color:#333333;font-weight:normal'>10</span><span style=3D'font-size:14.0p=
t;
  font-family:"MS PGothic";color:#333333;font-weight:normal'>&#26376;<span
  lang=3DEN-US>26</span>&#26085;&#65381;<span lang=3DEN-US>(</span>&#27700;=
<span
  lang=3DEN-US>)27</span>&#26085;<span lang=3DEN-US>(</span>&#26408;<span
  lang=3DEN-US>)<o:p></o:p></span></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;page-break-inside:avoid'>
  <td width=3D134 style=3D'width:80.4pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .75pt;mso-border-alt:solid windo=
wtext .75pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#22899;&#23376;&#65314;&#32026;<span lang=3DEN-US><o=
:p></o:p></span></span></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#65408;&#65438;&#65420;&#65438;&#65433;&#65405;&#122=
88;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D84 style=3D'width:50.55pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .75pt;mso-border-left-alt:solid windo=
wtext .75pt;
  mso-border-alt:solid windowtext .75pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothi=
c";
  color:#333333;font-weight:normal'>32</span><span style=3D'font-size:14.0p=
t;
  font-family:"MS PGothic";color:#333333;font-weight:normal'>&#32068;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D307 style=3D'width:184.05pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .75pt;mso-border-left-alt:solid windo=
wtext .75pt;
  mso-border-alt:solid windowtext .75pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-=
align:
  auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";color:#333=
333;
  font-weight:normal'>&#65297;&#65296;&#26376;&#65298;&#65301;&#26085;<span
  lang=3DEN-US>(</span>&#28779;<span lang=3DEN-US>)<o:p></o:p></span></span=
></p>
  <p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt'><span style=3D'=
font-size:
  14.0pt;font-family:"MS PGothic";color:#333333;font-weight:normal'>&#12522=
;&#12540;&#12464;&#25126;&#65374;&#27770;&#21213;&#65412;&#65392;&#65413;&#=
65426;&#65437;&#65412;&#25126;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal style=3D'text-indent:42.0pt;mso-char-indent-count:3.0;
mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span style=3D'font-=
size:
14.0pt;font-family:"MS PGothic";color:#333333;font-weight:normal'>&#8230;<s=
pan
lang=3DEN-US>B5</span>&#21448;&#12399;<span lang=3DEN-US>A4</span>&#29992;&=
#32025;&#12391;&#36865;&#12387;&#12390;&#19979;&#12373;&#12356;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'text-indent:56.0pt;mso-char-indent-count:4.0;
mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span style=3D'font-=
size:
14.0pt;font-family:"MS PGothic";color:#333333;font-weight:normal'>&#9312;&#=
12463;&#12521;&#12473;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'text-indent:56.0pt;mso-char-indent-count:4.0;
mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span style=3D'font-=
size:
14.0pt;font-family:"MS PGothic";color:#333333;font-weight:normal'>&#9313;&#=
12506;&#12450;&#20108;&#20154;&#12398;&#24481;&#21517;&#21069;&#12392;&#251=
52;&#23646;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'text-indent:56.0pt;mso-char-indent-count:4.0;
mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span style=3D'font-=
size:
14.0pt;font-family:"MS PGothic";color:#333333;font-weight:normal'>&#9314;&#=
12393;&#12385;&#12425;&#12363;&#20195;&#34920;&#32773;&#12398;&#24481;&#215=
17;&#21069;&#12392;&#36899;&#32097;&#20808;<span
lang=3DEN-US>(</span>&#25658;&#24111;&#21487;<span lang=3DEN-US>)<o:p></o:p=
></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothic";
font-weight:normal'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothic";
font-weight:normal'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:18.0pt;font-family:"MS PGothic";color:#FF660=
0;
font-weight:normal'>&#20849;&#36890;&#20107;&#38917;<span lang=3DEN-US><o:p=
></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#20250;
&#12288; &#22580;&#65306;&#12354;&#12369;&#12412;&#12398;&#12486;&#12491;&#=
12473;&#12463;&#12521;&#12502;<span
lang=3DEN-US>(</span><st1:MSNCTYST AddressList=3D"01:&#21271;&#28023;&#3694=
7;&#26413;&#24140;&#24066;&#25163;&#31282;&#21306;&#26329;&#20061;&#26465;;"
Address=3D"&#25163;&#31282;&#21306;&#26329;9" w:st=3D"on">&#25163;&#31282;&=
#21306;&#26329;<span
 lang=3DEN-US>9</span></st1:MSNCTYST>&#26465;<span lang=3DEN-US>2</span>&#1=
9969;&#30446;<span
lang=3DEN-US>2-10,</span>&#23627;&#22806;&#8230;&#12458;&#12512;&#12491;&#1=
2467;&#12540;&#12488;<span
lang=3DEN-US>8</span>&#38754;<span lang=3DEN-US>)</span></span><span lang=
=3DEN-US
style=3D'font-size:18.0pt;font-family:"MS PGothic";color:#FF6600;font-weigh=
t:
normal'><o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#35430;&#21512;&#26041;&#27861;&#65306;&#65302;&#12466;&#12540;&#1=
2512;&#20808;&#21462;&#12539;&#12494;&#12540;&#12450;&#12489;&#12496;&#1253=
1;&#12486;&#12540;&#12472;&#12288;&#12288;&#12288;&#12288;&#12288;&#12288;&=
#12288;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#21442;
&#21152; &#26009;&#65306;&#20491;&#20154;&#25126;&#12480;&#12502;&#12523;&#=
12473;&#65297;&#12506;&#12450;&#65381;&#65381;&#65381;<span
lang=3DEN-US>5,000</span>&#20870;<span lang=3DEN-US>(</span>&#31246;&#36796=
;<span
lang=3DEN-US>)</span>&#12288;&#22243;&#20307;&#25126;&#65297;&#12481;&#1254=
0;&#12512;&#65381;&#65381;&#65381;<span
lang=3DEN-US>15,000</span>&#20870;<span lang=3DEN-US>(</span>&#31246;&#3679=
6;<span
lang=3DEN-US>)<o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#30003;
&#36796; &#20808;&#65306;&#12354;&#12369;&#12412;&#12398;&#12486;&#12491;&#=
12473;&#12463;&#12521;&#12502;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'margin-left:308.0pt;text-indent:-308.0pt;mso-=
char-indent-count:
-22.0;mso-line-height-alt:12.0pt;mso-layout-grid-align:auto'><span lang=3DZ=
H-TW
style=3D'font-size:14.0pt;font-family:"MS PGothic";mso-fareast-language:ZH-=
TW;
font-weight:normal'>&#21463;&#20184;&#26399;&#38291;</span><span
style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:normal'>&#65=
306;</span><span
style=3D'font-size:22.0pt;font-family:"MS PGothic";color:red'>&#65305;&#263=
76;<span
lang=3DEN-US>1</span>&#26085;<span lang=3DEN-US>9:00</span>&#65374;</span><=
u><span
style=3D'font-size:14.0pt;font-family:"MS PGothic";color:red;layout-grid-mo=
de:
line;font-weight:normal'>&#8251;&#20840;&#12390;<span lang=3DEN-US>FAX</spa=
n>&#12391;&#12398;&#30003;&#12375;&#36796;&#12415;&#12395;&#12394;&#12426;&=
#12414;&#12377;<span
lang=3DEN-US><o:p></o:p></span></span></u></p>

<p class=3DMsoNormal style=3D'margin-left:308.1pt;mso-para-margin-left:6.65=
gd;
text-indent:-238.0pt;mso-char-indent-count:-17.0;mso-line-height-alt:12.0pt;
mso-layout-grid-align:auto'><span lang=3DEN-US style=3D'font-size:14.0pt;
font-family:"MS PGothic";color:red;layout-grid-mode:line;font-weight:normal=
'>FAX</span><span
style=3D'font-size:14.0pt;font-family:"MS PGothic";color:red;layout-grid-mo=
de:
line;font-weight:normal'>&#65306;</span><span lang=3DEN-US style=3D'font-si=
ze:22.0pt;
font-family:"MS PGothic";color:red;layout-grid-mode:line'>(011)681-4113</sp=
an><span
lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothic";color:red;
layout-grid-mode:line'>(24</span><span style=3D'font-size:14.0pt;font-famil=
y:
"MS PGothic";color:red;layout-grid-mode:line'>&#26178;&#38291;&#21463;&#201=
84;<span
lang=3DEN-US>)</span></span><span lang=3DEN-US style=3D'font-size:14.0pt;fo=
nt-family:
"MS PGothic";color:black;font-weight:normal'><o:p></o:p></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span lang=3DEN-US style=3D'font-size:14.0pt;font-family:"MS PGothic";
font-weight:normal'><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#30003;&#36796;&#12415;&#29992;&#32025;&#12399;&#12414;&#12=
392;&#12417;&#12394;&#12356;&#12391;&#19979;&#12373;&#12356;&#12290;<span
lang=3DEN-US>(</span>&#19968;&#12388;&#12398;&#22823;&#20250;&#12395;&#1996=
8;&#26522;&#12391;&#12377;<span
lang=3DEN-US>)<o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#23450;&#21729;&#12395;&#12394;&#12426;&#27425;&#31532;&#32=
224;&#12417;&#20999;&#12425;&#12379;&#12390;&#38914;&#12365;&#12414;&#12377=
;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#30003;&#36796;&#12415;&#24460;&#12398;&#12461;&#12515;&#12=
531;&#12475;&#12523;&#12399;&#20986;&#26469;&#12414;&#12379;&#12435;&#12290=
;&#65288;&#12506;&#12450;&#12398;&#22793;&#26356;&#12399;&#21487;&#65289;<s=
pan
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#36942;&#21435;&#12395;&#20778;&#21213;&#32076;&#39443;<span
lang=3DEN-US>(</span>&#65298;&#24230;&#20778;&#21213;&#12398;&#22580;&#2151=
2;&#12399;&#12463;&#12521;&#12473;&#12450;&#12483;&#12503;&#12375;&#12390;&=
#19979;&#12373;&#12356;<span
lang=3DEN-US>)</span>&#12398;&#12354;&#12427;&#26041;&#12399;<span lang=3DE=
N-US>,</span>&#12506;&#12450;&#12434;&#22793;&#26356;&#12375;&#12390;&#1997=
9;&#12373;&#12356;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#65314;&#32026;&#12391;<span
lang=3DEN-US>,</span>&#21435;&#24180;&#12414;&#12391;&#12395;<span lang=3DE=
N-US>(</span>&#12377;&#12409;&#12390;&#12398;&#22823;&#20250;&#12395;&#1236=
2;&#12356;&#12390;<span
lang=3DEN-US>)</span>&#65298;&#22238;&#20197;&#19978;&#20778;&#21213;&#1237=
5;&#12390;&#12356;&#12427;&#26041;&#12399;<span
lang=3DEN-US>,</span>&#20170;&#22238;&#65314;&#32026;&#12463;&#12521;&#1247=
3;&#12395;&#12399;&#20986;&#22580;&#20986;&#26469;&#12414;&#12379;&#12435;&=
#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoNormal style=3D'mso-line-height-alt:12.0pt;mso-layout-grid-al=
ign:
auto'><span style=3D'font-size:14.0pt;font-family:"MS PGothic";font-weight:=
normal'>&#8251;&#12489;&#12525;&#12540;&#30330;&#34920;&#8230;&#24403;&#260=
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