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97;&#12288;&#27973;&#21475;&#24066;&#38450;&#28797;&#20250;&#35696;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#28797;&=
#23475;&#23550;&#31574;&#22522;&#26412;&#27861;&#31532;<span
lang=3DEN-US>16</span>&#26465;&#12398;&#35215;&#23450;&#12395;&#22522;&#123=
89;&#12365;&#12289;&#24066;&#12395;&#27973;&#21475;&#24066;&#38450;&#28797;=
&#20250;&#35696;&#12434;&#35373;&#32622;&#12377;&#12427;&#12290;&#38450;&#2=
8797;&#20250;&#35696;&#12398;&#32068;&#32340;&#21450;&#12403;&#25152;&#2548=
4;&#20107;&#21209;&#12399;&#27425;&#12398;&#12392;&#12362;&#12426;&#12391;&=
#12354;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;<span
lang=3DEN-US>(1)</span>&#12288;&#32068;&#12288;&#32340;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12450;&#12288;&#20250;&#38263;&#12288;&#24066;&#38263;=
</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12452;&#12288;&#22996;&#21729;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12450;<sp=
an
lang=3DEN-US>)</span>&#12288;&#23713;&#23665;&#30476;&#12398;&#30693;&#2010=
7;&#12398;&#37096;&#20869;&#12398;&#32887;&#21729;&#12398;&#12358;&#12385;&=
#12363;&#12425;&#24066;&#38263;&#12364;&#22996;&#22065;&#12377;&#12427;&#32=
773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12452;<sp=
an
lang=3DEN-US>)</span>&#12288;&#23713;&#23665;&#30476;&#35686;&#23519;&#1239=
8;&#35686;&#23519;&#23448;&#12398;&#12358;&#12385;&#12363;&#12425;&#24066;&=
#38263;&#12364;&#22996;&#22065;&#12377;&#12427;&#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12454;<sp=
an
lang=3DEN-US>)</span>&#12288;&#25351;&#23450;&#34892;&#25919;&#27231;&#3830=
6;&#21448;&#12399;&#25351;&#23450;&#22320;&#26041;&#34892;&#25919;&#27231;&=
#38306;&#12398;&#32887;&#21729;&#12398;&#12358;&#12385;&#12363;&#12425;&#24=
066;&#38263;&#12364;&#22996;&#22065;&#12377;&#12427;&#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12456;<sp=
an
lang=3DEN-US>)</span>&#12288;&#24066;&#38263;&#12364;&#12381;&#12398;&#3709=
6;&#20869;&#12398;&#32887;&#21729;&#12398;&#12358;&#12385;&#12363;&#12425;&=
#20219;&#21629;&#12377;&#12427;&#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12458;<sp=
an
lang=3DEN-US>)</span>&#12288;&#25945;&#32946;&#38263;<span lang=3DEN-US><o:=
p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12459;<sp=
an
lang=3DEN-US>)</span>&#12288;&#24066;&#38263;&#12364;&#28040;&#38450;&#2224=
3;&#12398;&#12358;&#12385;&#12363;&#12425;&#22996;&#22065;&#12377;&#12427;&=
#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12461;<sp=
an
lang=3DEN-US>)</span>&#12288;&#25351;&#23450;&#20844;&#20849;&#27231;&#3830=
6;&#21448;&#12399;&#25351;&#23450;&#22320;&#26041;&#20844;&#20849;&#27231;&=
#38306;&#12398;&#32887;&#21729;&#12398;&#12358;&#12385;&#12363;&#12425;&#24=
066;&#38263;&#12364;&#22996;&#22065;&#12377;&#12427;&#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;<span lang=3DEN-US>(</span>&#12463;<sp=
an
lang=3DEN-US>)</span>&#12288;&#21069;&#21508;&#21495;&#12395;&#25522;&#1237=
0;&#12427;&#12418;&#12398;&#12398;&#12411;&#12363;&#12289;&#24066;&#38263;&=
#12364;&#29305;&#12395;&#24517;&#35201;&#12392;&#12375;&#12390;&#22996;&#22=
065;&#12377;&#12427;&#32773;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;<span lang=3DEN-US>(2)</span>&#12288;&#25152;&#25484;&=
#20107;&#21209;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12450;&#12288;&#27973;&#21475;&#24066;&#2232=
0;&#22495;&#38450;&#28797;&#35336;&#30011;&#12434;&#20316;&#25104;&#12375;&=
#12289;&#12381;&#12398;&#23455;&#26045;&#12434;&#25512;&#36914;&#12377;&#12=
427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'><span style=3D'ms=
o-hansi-font-family:
"MS Mincho"'>&#12288;&#12288;&#12452;&#12288;&#24066;&#12398;&#22320;&#2249=
5;&#12395;&#20418;&#12427;&#28797;&#23475;&#12364;&#30330;&#29983;&#12375;&=
#12383;&#22580;&#21512;&#12395;&#12362;&#12356;&#12390;&#12289;&#24403;&#35=
442;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#24773;&#22577;&#12434=
;&#21454;&#38598;&#12377;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'><span style=3D'mso-hansi-font-family:"MS Minc=
ho"'>&#12288;&#12288;&#12454;&#12288;&#21069;&#65298;&#21495;&#12395;&#2552=
2;&#12370;&#12427;&#12418;&#12398;&#12398;&#12411;&#12363;&#12289;&#27861;&=
#24459;&#21448;&#12399;&#12371;&#12428;&#12395;&#22522;&#12389;&#12367;&#25=
919;&#20196;&#12395;&#12424;&#12426;&#12381;&#12398;&#27177;&#38480;&#12395=
;&#23646;&#12377;&#12427;&#20107;&#21209;&#12434;&#34892;&#12358;&#12290;<s=
pan
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'>&#652=
98;&#12288;&#27973;&#21475;&#24066;&#28797;&#23475;&#23550;&#31574;&#26412;=
&#37096;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#24066;&=
#38263;&#12399;&#12289;&#24066;&#22495;&#12395;&#28797;&#23475;&#12364;&#30=
330;&#29983;&#12375;&#12289;&#21448;&#12399;&#28797;&#23475;&#12364;&#30330=
;&#29983;&#12377;&#12427;&#12362;&#12381;&#12428;&#12364;&#12354;&#12427;&#=
22580;&#21512;&#12395;&#24540;&#12376;&#12390;&#12289;&#36805;&#36895;&#123=
63;&#12388;&#30340;&#30906;&#12394;&#28797;&#23475;&#23550;&#31574;&#12434;=
&#23455;&#26045;&#12377;&#12427;&#12383;&#12417;&#24517;&#35201;&#12364;&#1=
2354;&#12427;&#12392;&#35469;&#12417;&#12383;&#12392;&#12365;&#12289;&#2879=
7;&#23475;&#23550;&#31574;&#22522;&#26412;&#27861;&#65288;&#26157;&#21644;<=
span
lang=3DEN-US>36</span>&#24180;&#27861;&#24459;&#31532;<span lang=3DEN-US>22=
3</span>&#21495;&#65289;&#31532;<span
lang=3DEN-US>23</span>&#26465;&#21450;&#12403;&#27973;&#21475;&#24066;&#287=
97;&#23475;&#23550;&#31574;&#26412;&#37096;&#26465;&#20363;&#12395;&#22522;=
&#12389;&#12365;&#12289;&#27973;&#21475;&#24066;&#28797;&#23475;&#23550;&#3=
1574;&#26412;&#37096;&#65288;&#20197;&#19979;&#12300;&#26412;&#37096;&#1230=
1;&#12392;&#12356;&#12358;&#12290;&#65289;&#12434;&#35373;&#32622;&#12377;&=
#12427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;<span
lang=3DEN-US>(1)</span>&#12288;&#26412;&#37096;&#12398;&#35373;&#32622;&#21=
450;&#12403;&#24259;&#27490;</p>

<p class=3DMsoPlainText style=3D'margin-bottom:5.0pt;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#12450;&#12288;&#35373;&#32622;&#2145=
0;&#12403;&#24259;&#27490;&#12398;&#22522;&#28310;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D547
 style=3D'width:410.4pt;margin-left:46.95pt;border-collapse:collapse;border=
:none;
 mso-border-alt:solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;
 mso-border-insideh:.5pt solid windowtext;mso-border-insidev:.5pt solid win=
dowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:21.2pt'>
  <td width=3D77 valign=3Dtop style=3D'width:57.75pt;border:solid windowtex=
t 1.0pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:21.2pt'>
  <p class=3Da style=3D'text-align:justify;text-justify:distribute-all-line=
s;
  punctuation-wrap:simple'>&#35373;&#32622;&#22522;&#28310;</p>
  </td>
  <td width=3D470 valign=3Dtop style=3D'width:352.65pt;border:solid windowt=
ext 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;height:21.2pt'>
  <p class=3Da style=3D'punctuation-wrap:simple'>&#9312;&#12288;&#24066;&#2=
0869;&#20840;&#22495;&#12395;&#12431;&#12383;&#12427;&#28797;&#23475;&#1236=
4;&#30330;&#29983;&#12375;&#12289;&#21448;&#12399;&#30330;&#29983;&#12377;&=
#12427;&#12362;&#12381;&#12428;&#12364;&#12354;&#12427;&#12392;&#12365;&#12=
290;</p>
  <p class=3Da style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso-char-ind=
ent-count:
  -1.0;punctuation-wrap:simple'>&#9313;&#12288;&#23616;&#22320;&#30340;&#12=
394;&#28797;&#23475;&#12391;&#12354;&#12387;&#12390;&#12418;&#34987;&#23475=
;&#12364;&#29978;&#22823;&#12391;&#12354;&#12426;&#12289;&#26412;&#24193;&#=
65293;&#25903;&#25152;&#38291;&#21448;&#12399;&#25903;&#25152;&#21516;&#227=
63;&#12398;&#24540;&#25588;&#21332;&#21147;&#12364;&#19981;&#21487;&#27424;=
&#12391;&#12354;&#12427;&#12392;&#12365;&#12290;</p>
  <p class=3Da style=3D'punctuation-wrap:simple'>&#9314;&#12288;&#12381;&#1=
2398;&#20182;&#12398;&#29366;&#27841;&#12395;&#12424;&#12426;&#12289;&#2406=
6;&#38263;&#12364;&#24517;&#35201;&#12392;&#35469;&#12417;&#12383;&#12392;&=
#12365;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;height:21.35pt'>
  <td width=3D77 valign=3Dtop style=3D'width:57.75pt;border:solid windowtex=
t 1.0pt;
  border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:s=
olid windowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:21.35pt'>
  <p class=3Da style=3D'text-align:justify;text-justify:distribute-all-line=
s;
  punctuation-wrap:simple'>&#24259;&#27490;&#22522;&#28310;</p>
  </td>
  <td width=3D470 valign=3Dtop style=3D'width:352.65pt;border-top:none;bord=
er-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:21.35pt'>
  <p class=3Da style=3D'punctuation-wrap:simple'>&#9312;&#12288;&#24066;&#3=
8263;&#12364;&#12289;&#20104;&#24819;&#12373;&#12428;&#12383;&#28797;&#2347=
5;&#12398;&#21361;&#38522;&#12364;&#35299;&#28040;&#12375;&#12383;&#12392;&=
#35469;&#12417;&#12383;&#12392;&#12365;&#12290;</p>
  <p class=3Da style=3D'punctuation-wrap:simple'>&#9313;&#12288;&#28797;&#2=
3475;&#24540;&#24613;&#23550;&#31574;&#12364;&#12362;&#12362;&#12416;&#1239=
7;&#23436;&#20102;&#12375;&#12383;&#12392;&#35469;&#12417;&#12383;&#12392;&=
#12365;&#12290;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;punctuation-wrap:simple;
text-autospace:none'>&#12288;&#12288;&#12452;&#12288;&#35373;&#32622;&#2145=
0;&#12403;&#24259;&#27490;&#12398;&#36890;&#30693;</p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;&=
#12288;&#26412;&#37096;&#12434;&#35373;&#32622;&#21448;&#12399;&#24259;&#27=
490;&#12375;&#12383;&#12392;&#12365;&#12399;&#12289;&#30452;&#12385;&#12395=
;&#12381;&#12398;&#26088;&#12434;&#38450;&#28797;&#34892;&#25919;&#28961;&#=
32218;&#12289;&#12465;&#12540;&#12502;&#12523;&#12486;&#12524;&#12499;&#315=
61;&#12395;&#12424;&#12426;&#12289;&#30476;&#12289;&#38306;&#20418;&#27231;=
&#38306;&#12289;&#20303;&#27665;&#12395;&#23550;&#12375;&#12289;&#22577;&#2=
1578;&#12289;&#36890;&#30693;&#12289;&#20844;&#34920;&#12377;&#12427;&#1239=
2;&#12392;&#12418;&#12395;&#12289;&#24066;&#24441;&#25152;&#29572;&#38306;&=
#21069;&#12395;&#26412;&#37096;&#12398;&#27161;&#35672;&#12434;&#25522;&#31=
034;&#21448;&#12399;&#25764;&#21435;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12454;&#12288;&#35373;&#32622;&#31561;&#27177;&#38480;=
&#12398;&#20195;&#29702;&#32773;</p>

<p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-bot=
tom:
5.0pt;margin-left:31.5pt;text-indent:-31.5pt;mso-char-indent-count:-3.0;
punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;&#1228=
8;&#26412;&#37096;&#12398;&#35373;&#32622;&#21448;&#12399;&#24259;&#27490;&=
#12398;&#27770;&#23450;&#27177;&#38480;&#12399;&#12289;&#24066;&#38263;&#12=
395;&#12354;&#12427;&#12364;&#12289;&#24066;&#38263;&#12364;&#19981;&#22312=
;&#12398;&#22580;&#21512;&#12398;&#32887;&#21209;&#20195;&#29702;&#38918;&#=
20301;&#32773;&#12399;&#12289;&#27425;&#12398;&#12392;&#12362;&#12426;&#123=
92;&#12377;&#12427;&#12290;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D553
 style=3D'width:414.75pt;margin-left:41.7pt;border-collapse:collapse;border=
:none;
 mso-border-alt:solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;
 mso-border-insideh:.5pt solid windowtext;mso-border-insidev:.5pt solid win=
dowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes;
  height:19.0pt'>
  <td width=3D119 style=3D'width:89.25pt;border:solid windowtext 1.0pt;mso-=
border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#32887;&#212=
09;&#27177;&#38480;&#38918;&#20301;</p>
  </td>
  <td width=3D35 style=3D'width:26.25pt;border:solid windowtext 1.0pt;borde=
r-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#65297;</p>
  </td>
  <td width=3D101 style=3D'width:75.75pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#21103;&#240=
66;&#38263;&#8251;</p>
  </td>
  <td width=3D32 style=3D'width:24.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#65298;</p>
  </td>
  <td width=3D112 style=3D'width:84.0pt;border:solid windowtext 1.0pt;borde=
r-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#21103;&#240=
66;&#38263;&#8251;</p>
  </td>
  <td width=3D28 style=3D'width:21.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#65299;</p>
  </td>
  <td width=3D126 style=3D'width:94.5pt;border:solid windowtext 1.0pt;borde=
r-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;line-height:normal;punctuation-wrap:simple'>&#25945;&#329=
46;&#38263;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;punctuation-wrap:simple;
text-autospace:none'>&#12288;&#12288;&#12288;&#12288;&#8251;&#12395;&#12388=
;&#12356;&#12390;&#12399;&#12289;&#24066;&#38263;&#12364;&#12354;&#12425;&#=
12363;&#12376;&#12417;&#23450;&#12417;&#12427;&#38918;&#20301;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12456;&#12288;&#26412;&#37096;&#12398;&#35373;&#32622;=
&#22580;&#25152;</p>

<p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-bot=
tom:
5.0pt;margin-left:31.5pt;text-indent:-31.5pt;mso-char-indent-count:-3.0;
punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;&#1228=
8;&#26412;&#37096;&#12399;&#12289;&#26412;&#24193;&#20250;&#35696;&#23460;&=
#12395;&#35373;&#32622;&#12377;&#12427;&#12290;&#12383;&#12384;&#12375;&#12=
289;&#24193;&#33294;&#12398;&#34987;&#28797;&#31561;&#12395;&#12424;&#12426=
;&#12289;&#26412;&#37096;&#12392;&#12375;&#12390;&#27231;&#33021;&#12391;&#=
12365;&#12394;&#12356;&#12392;&#24066;&#38263;&#12364;&#21028;&#26029;&#123=
75;&#12383;&#12392;&#12365;&#12399;&#12289;&#27425;&#12398;&#38918;&#20301;=
&#12395;&#12424;&#12426;&#26412;&#37096;&#12434;&#31227;&#35373;&#12377;&#1=
2427;&#12290;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:41.7pt;border-collapse:collapse;border:none;mso-borde=
r-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;mso-yfti-lastrow:yes;
  height:19.0pt'>
  <td width=3D77 valign=3Dtop style=3D'width:57.75pt;border:solid windowtex=
t 1.0pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;punctuation-wrap:simple'>&#31532;&#65297;&#38918;&#20301;=
</p>
  </td>
  <td width=3D182 valign=3Dtop style=3D'width:136.5pt;border:solid windowte=
xt 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;punctuation-wrap:simple'>&#37329;&#20809;&#32207;&#21512;=
&#25903;&#25152;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:solid windowtext=
 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;punctuation-wrap:simple'>&#31532;&#65298;&#38918;&#20301;=
</p>
  </td>
  <td width=3D224 valign=3Dtop style=3D'width:168.0pt;border:solid windowte=
xt 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;height:19.0pt'>
  <p class=3Da style=3D'margin-top:5.0pt;margin-right:0mm;margin-bottom:5.0=
pt;
  margin-left:0mm;punctuation-wrap:simple'>&#23492;&#23798;&#32207;&#21512;=
&#25903;&#25152;</p>
  </td>
 </tr>
</table>

<h2 style=3D'margin-top:5.0pt;punctuation-wrap:simple'><span style=3D'font-=
family:
"MS Mincho"'>&#12288;<span lang=3DEN-US>(2)</span>&#12288;&#26412;&#37096;&=
#12398;&#20219;&#21209;<span
lang=3DEN-US><o:p></o:p></span></span></h2>

<p class=3DMsoBodyText2 style=3D'margin-left:0mm'>&#12288;&#12288;&#12288;&=
#26412;&#37096;&#12399;&#12289;&#27425;&#12398;&#20219;&#21209;&#12434;&#36=
930;&#34892;&#12377;&#12427;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12450;&#12288;&#28797;&#23475;&#12=
395;&#38306;&#12377;&#12427;&#24773;&#22577;&#12398;&#21454;&#38598;&#21450=
;&#12403;&#20253;&#36948;&#12434;&#34892;&#12358;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12452;&#12288;&#28797;&#23475;&#24=
540;&#24613;&#23550;&#31574;&#12398;&#36899;&#32097;&#35519;&#25972;&#12434=
;&#34892;&#12358;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12454;&#12288;&#27700;&#38450;&#12=
289;&#12381;&#12398;&#20182;&#28797;&#23475;&#12398;&#24540;&#24613;&#23550=
;&#31574;&#12434;&#34892;&#12358;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12456;&#12288;&#28797;&#23475;&#25=
937;&#21161;&#12289;&#12381;&#12398;&#20182;&#12398;&#27665;&#29983;&#23433=
;&#23450;&#12398;&#12383;&#12417;&#12398;&#23550;&#31574;&#12434;&#34892;&#=
12358;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12458;&#12288;&#26045;&#35373;&#21=
450;&#12403;&#35373;&#20633;&#12398;&#24540;&#24613;&#24489;&#26087;&#12434=
;&#34892;&#12358;&#12290;</p>

<p class=3DMsoBodyText>&#12288;&#12288;&#12459;&#12288;&#12381;&#12398;&#20=
182;&#28797;&#23475;&#12398;&#30330;&#29983;&#12398;&#38450;&#24481;&#21448=
;&#12399;&#25313;&#22823;&#12398;&#38450;&#27490;&#12398;&#12383;&#12417;&#=
12398;&#25514;&#32622;&#12434;&#34892;&#12358;&#12290;</p>

<h2 style=3D'punctuation-wrap:simple'><span style=3D'font-family:"MS Mincho=
"'>&#12288;<span
lang=3DEN-US>(3)</span>&#12288;&#26412;&#37096;&#12398;&#32068;&#32340;<span
lang=3DEN-US><o:p></o:p></span></span></h2>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12450;&#12288;&#26412;&#370=
96;&#38263;&#65288;&#24066;&#38263;&#65289;</h3>

<p class=3DMsoBodyText3 style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#26412;&#37096;&#38263;&#12399;&#12289;&#26412;&#37096;&#12398;&#20107;&#21=
209;&#12434;&#32207;&#25324;&#12375;&#12289;&#26412;&#37096;&#32887;&#21729=
;&#12434;&#25351;&#25582;&#30435;&#30563;&#12377;&#12427;&#12290;</p>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12452;&#12288;&#21103;&#264=
12;&#37096;&#38263;&#65288;&#21103;&#24066;&#38263;&#12539;&#25945;&#32946;=
&#38263;&#12539;&#28040;&#38450;&#22243;&#38263;&#65289;</h3>

<p class=3DMsoBodyText3 style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#21103;&#26412;&#37096;&#38263;&#12399;&#12289;&#26412;&#37096;&#38263;&#12=
434;&#35036;&#20304;&#12375;&#12289;&#26412;&#37096;&#38263;&#12395;&#20107=
;&#25925;&#12354;&#12427;&#12392;&#12365;&#12399;&#12289;&#12381;&#12398;&#=
32887;&#21209;&#12434;&#20195;&#29702;&#12377;&#12427;&#12290;</p>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12454;&#12288;&#26412;&#370=
96;&#21729;&#65288;&#37096;&#38263;&#32887;&#12398;&#32887;&#21729;&#12539;=
&#28040;&#38450;&#22243;&#21103;&#22243;&#38263;&#65289;</h3>

<p class=3DMsoBodyText3 style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'>&#12288;&#12288;&#12288;&#12288;&#26412;&#370=
96;&#21729;&#12399;&#12289;&#26412;&#37096;&#38263;&#12398;&#21629;&#12434;=
&#21463;&#12369;&#12289;&#26412;&#37096;&#12398;&#20107;&#21209;&#12395;&#2=
4467;&#20107;&#12377;&#12427;&#12392;&#12392;&#12418;&#12395;&#12289;&#2515=
2;&#23646;&#12398;&#29677;&#38263;&#31561;&#12434;&#25351;&#25582;&#30435;&=
#30563;&#12377;&#12427;&#12290;</p>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12456;&#12288;&#37096;&#214=
50;&#12403;&#29677;</h3>

<p class=3DMsoBodyText3 style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'>&#12288;&#12288;&#12288;&#12288;&#26412;&#370=
96;&#12395;&#12362;&#12369;&#12427;&#21508;&#37096;&#21450;&#12403;&#29677;=
&#12398;&#32068;&#32340;&#21450;&#12403;&#12381;&#12428;&#12382;&#12428;&#1=
2398;&#25152;&#25484;&#20107;&#21209;&#12395;&#12388;&#12356;&#12390;&#1239=
9;&#12289;<span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:Century'>&#21029;&#3=
2025;</span>&#12395;&#23450;&#12417;&#12427;&#12392;&#12371;&#12429;&#12395=
;&#12424;&#12427;&#12290;</p>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12458;&#12288;&#25903;&#370=
96;</h3>

<h4 style=3D'punctuation-wrap:simple'>&#12288;<span lang=3DEN-US>(</span>&#=
12450;<span
lang=3DEN-US>)</span>&#12288;&#37329;&#20809;&#12539;&#23492;&#23798;&#1239=
8;&#21508;&#25903;&#25152;&#12395;&#28797;&#23475;&#23550;&#31574;&#25903;&=
#37096;&#12434;&#32622;&#12367;&#12290;</h4>

<h4 style=3D'margin-left:52.5pt;text-indent:-31.5pt;punctuation-wrap:simple=
'>&#12288;<span
lang=3DEN-US>(</span>&#12452;<span lang=3DEN-US>)</span>&#12288;&#25903;&#3=
7096;&#12399;&#12289;&#26412;&#37096;&#38263;&#12398;&#25351;&#31034;&#1239=
5;&#24467;&#12387;&#12390;&#12289;&#31649;&#36676;&#21306;&#22495;&#12398;&=
#28797;&#23475;&#24773;&#22577;&#12398;&#21454;&#38598;&#12289;&#20303;&#27=
665;&#12398;&#36991;&#38627;&#35480;&#23566;&#12289;&#34987;&#28797;&#32773=
;&#12398;&#25937;&#21161;&#27963;&#21205;&#31561;&#12398;&#28797;&#23475;&#=
24540;&#24613;&#23550;&#31574;&#27963;&#21205;&#12395;&#24467;&#20107;&#123=
77;&#12427;&#12290;</h4>

<h4 style=3D'punctuation-wrap:simple'>&#12288;<span lang=3DEN-US>(</span>&#=
12454;<span
lang=3DEN-US>)</span>&#12288;&#25903;&#37096;&#12398;&#32068;&#32340;&#2145=
0;&#12403;&#21508;&#29677;&#12398;&#25152;&#25484;&#20107;&#21209;&#12395;&=
#12388;&#12356;&#12390;&#12399;&#12289;<span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:Century'>&#21029;&#3=
2025;</span>&#12395;&#23450;&#12417;&#12427;&#12392;&#12371;&#12429;&#12395=
;&#12424;&#12427;&#12290;</h4>

<h3 style=3D'punctuation-wrap:simple'>&#12288;&#12459;&#12288;&#29694;&#223=
20;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;</h3>

<p class=3DMsoBodyText3 style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'>&#12288;&#12288;&#12288;&#12288;&#28797;&#234=
75;&#12398;&#29366;&#27841;&#12395;&#12424;&#12426;&#12289;&#26412;&#37096;=
&#38263;&#12364;&#24517;&#35201;&#12392;&#35469;&#12417;&#12427;&#12392;&#1=
2365;&#12399;&#12289;&#28797;&#23475;&#29694;&#22580;&#20184;&#36817;&#1239=
5;&#29694;&#22320;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;&#12434;&=
#35373;&#32622;&#12375;&#12289;&#28797;&#23475;&#24540;&#24613;&#23550;&#31=
574;&#27963;&#21205;&#12398;&#25351;&#25582;&#12434;&#34892;&#12358;&#12418=
;&#12398;&#12392;&#12377;&#12427;&#12290;</p>

<h4 style=3D'punctuation-wrap:simple'>&#12288;<span lang=3DEN-US>(</span>&#=
12450;<span
lang=3DEN-US>)</span>&#12288;&#29694;&#22320;&#28797;&#23475;&#23550;&#3157=
4;&#26412;&#37096;&#12398;&#38283;&#35373;</h4>

<h5 style=3D'punctuation-wrap:simple'>&#12288;&#65345;&#12288;&#26412;&#370=
96;&#38263;&#12399;&#12289;&#29694;&#22320;&#28797;&#23475;&#23550;&#31574;=
&#26412;&#37096;&#38263;&#12392;&#12375;&#12390;&#21103;&#24066;&#38263;&#1=
2434;&#20805;&#12390;&#12289;&#12414;&#12383;&#12289;&#26412;&#37096;&#3288=
7;&#21729;&#12398;&#12358;&#12385;&#12363;&#12425;&#29694;&#22320;&#28797;&=
#23475;&#23550;&#31574;&#26412;&#37096;&#21729;&#12434;&#25351;&#21517;&#12=
375;&#12289;&#29694;&#22320;&#12408;&#27966;&#36963;&#12377;&#12427;&#12290=
;</h5>

<h5 style=3D'punctuation-wrap:simple'>&#12288;&#65346;&#12288;&#29694;&#223=
20;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;&#12399;&#12289;&#26368;=
&#23492;&#12426;&#12398;&#20844;&#20849;&#26045;&#35373;&#12395;&#35373;&#3=
2622;&#12377;&#12427;&#12364;&#12289;&#36969;&#24403;&#12394;&#26045;&#3537=
3;&#12364;&#12394;&#12356;&#22580;&#21512;&#12395;&#12399;&#12289;&#27665;&=
#38291;&#26045;&#35373;&#12398;&#20511;&#19978;&#12370;&#21448;&#12399;&#20=
206;&#35373;&#12486;&#12531;&#12488;&#12398;&#35373;&#32622;&#31561;&#12395=
;&#12424;&#12427;&#12290;</h5>

<h5 style=3D'punctuation-wrap:simple'>&#12288;&#65347;&#12288;&#29694;&#223=
20;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;&#12434;&#38283;&#35373;=
&#12375;&#12383;&#12392;&#12365;&#12399;&#12289;&#31435;&#30475;&#26495;&#1=
2289;&#12398;&#12412;&#12426;&#31561;&#12391;&#34920;&#31034;&#12377;&#1242=
7;&#12290;</h5>

<h4 style=3D'punctuation-wrap:simple'>&#12288;<span lang=3DEN-US>(</span>&#=
12452;<span
lang=3DEN-US>)</span>&#12288;&#29694;&#22320;&#28797;&#23475;&#23550;&#3157=
4;&#26412;&#37096;&#12398;&#36012;&#21209;</h4>

<h5 style=3D'punctuation-wrap:simple'>&#12288;&#65345;&#12288;&#28797;&#234=
75;&#12398;&#29366;&#27841;&#12289;&#28797;&#23475;&#29694;&#22580;&#20986;=
&#21205;&#37096;&#38538;&#12398;&#27963;&#21205;&#29366;&#27841;&#12434;&#3=
0340;&#30906;&#12395;&#25226;&#25569;&#12375;&#12289;&#20303;&#27665;&#1239=
8;&#23433;&#20840;&#30906;&#20445;&#12289;&#34987;&#23475;&#12398;&#25313;&=
#22823;&#38450;&#27490;&#12434;&#12377;&#12427;&#12290;</h5>

<h5 style=3D'punctuation-wrap:simple'>&#12288;&#65346;&#12288;&#20986;&#212=
05;&#27231;&#38306;&#30456;&#20114;&#38291;&#12398;&#25351;&#25582;&#21450;=
&#12403;&#24773;&#22577;&#36899;&#32097;&#20307;&#21046;&#12398;&#32207;&#2=
5324;&#12434;&#22259;&#12427;&#12290;</h5>

<p class=3DMsoNormal>&#12288;&#12288;&#12288;&#12288;&#65347;&#12288;&#2083=
7;&#25163;&#12375;&#12383;&#24773;&#22577;&#12434;&#36880;&#27425;&#28797;&=
#23475;&#23550;&#31574;&#26412;&#37096;&#12408;&#22577;&#21578;&#12377;&#12=
427;&#12290;</p>

<p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none'>=
&#12288;&#12288;&#12288;<span
lang=3DEN-US>(</span>&#12454;<span lang=3DEN-US>)</span>&#12288;&#26412;&#3=
7096;&#12392;&#29694;&#22320;&#28797;&#23475;&#23550;&#31574;&#26412;&#3709=
6;&#12392;&#12398;&#38306;&#20418;<span
lang=3DEN-US style=3D'mso-hansi-font-family:"Times New Roman"'><o:p></o:p><=
/span></p>

<p class=3DMsoNormal style=3D'margin-left:52.5pt;mso-para-margin-left:3.0gd;
text-indent:-21.0pt;mso-char-indent-count:-2.0;punctuation-wrap:simple;
text-autospace:none'>&#12288;&#65345;&#12288;&#29694;&#22320;&#28797;&#2347=
5;&#23550;&#31574;&#26412;&#37096;&#12399;&#12289;&#26412;&#37096;&#12398;&=
#25351;&#31034;&#12395;&#22522;&#12389;&#12365;&#12289;&#29694;&#22320;&#12=
391;&#12398;&#28797;&#23475;&#24540;&#24613;&#27963;&#21205;&#12395;&#24403=
;&#12383;&#12427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;&#12383;&#=
12384;&#12375;&#12289;&#20107;&#24907;&#12364;&#20999;&#36843;&#12375;&#122=
89;&#32202;&#24613;&#12395;&#23550;&#20966;&#12377;&#12427;&#24517;&#35201;=
&#12364;&#12354;&#12427;&#22580;&#21512;&#12395;&#12399;&#12289;&#29694;&#2=
2320;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;&#38263;&#12398;&#2535=
1;&#31034;&#12395;&#12424;&#12426;&#27963;&#21205;&#12377;&#12427;&#12371;&=
#12392;&#12364;&#12391;&#12365;&#12427;&#12290;&#12371;&#12398;&#22580;&#21=
512;&#12289;&#20107;&#24460;&#30452;&#12385;&#12395;&#26412;&#37096;&#38263=
;&#12395;&#22577;&#21578;&#12377;&#12427;&#12418;&#12398;&#12392;&#12377;&#=
12427;&#12290;<span
lang=3DEN-US style=3D'mso-hansi-font-family:"Times New Roman"'><o:p></o:p><=
/span></p>

<p class=3DMsoNormal style=3D'margin-left:52.5pt;mso-para-margin-left:3.0gd;
text-indent:-21.0pt;mso-char-indent-count:-2.0;punctuation-wrap:simple;
text-autospace:none'>&#12288;&#65346;&#12288;&#26412;&#37096;&#12392;&#2969=
4;&#22320;&#28797;&#23475;&#23550;&#31574;&#26412;&#37096;&#12392;&#12399;&=
#12289;&#23450;&#26399;&#30340;&#12395;&#24773;&#22577;&#20132;&#25563;&#12=
434;&#34892;&#12356;&#12289;&#24847;&#24605;&#30094;&#36890;&#12434;&#22259=
;&#12427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;<span
lang=3DEN-US style=3D'mso-hansi-font-family:"Times New Roman"'><o:p></o:p><=
/span></p>

<p class=3DMsoNormal style=3D'margin-left:52.5pt;mso-para-margin-left:3.0gd;
text-indent:-21.0pt;mso-char-indent-count:-2.0;punctuation-wrap:simple;
text-autospace:none'>&#12288;&#65347;&#12288;&#29694;&#22320;&#28797;&#2347=
5;&#23550;&#31574;&#26412;&#37096;&#38263;&#12399;&#12289;&#29694;&#22320;&=
#12395;&#12362;&#12369;&#12427;&#28797;&#23475;&#24540;&#24613;&#27963;&#21=
205;&#12395;&#24517;&#35201;&#12394;&#20154;&#21729;&#12289;&#36039;&#27231=
;&#26448;&#31561;&#12364;&#19981;&#36275;&#12377;&#12427;&#22580;&#21512;&#=
12395;&#12399;&#12289;&#26412;&#37096;&#38263;&#12395;&#24540;&#25588;&#124=
34;&#35201;&#35531;&#12377;&#12427;&#12418;&#12398;&#12392;&#12377;&#12427;=
&#12290;</p>

<span lang=3DEN-US style=3D'font-size:10.5pt;mso-bidi-font-size:10.0pt;font=
-family:
"MS Mincho";mso-hansi-font-family:"Courier New";mso-bidi-font-family:"Times=
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mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:JA;
mso-bidi-language:AR-SA'><br clear=3Dall style=3D'page-break-before:always'>
</span>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
style=3D'font-family:"MS Gothic";mso-ascii-font-family:"MS Mincho";mso-hans=
i-font-family:
"Courier New"'>&#21029;&#32025;&#12288;</span><span style=3D'font-family:"M=
S Gothic";
mso-hansi-font-family:"Courier New"'>&#27973;&#21475;&#24066;&#28797;&#2347=
5;&#23550;&#31574;&#26412;&#37096;&#32068;&#32340;&#34920;<span
lang=3DEN-US><o:p></o:p></span></span></p>

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e'><!--[if gte vml 1]><o:wrapblock
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  center;line-height:12.0pt;mso-line-height-rule:exactly;punctuation-wrap:s=
imple;
  text-autospace:none'>&#65288;&#29677;&#38263;&#65289;</p>
  </td>
  <td width=3D70 style=3D'width:52.5pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'text-align:center;punctua=
tion-wrap:
  simple;text-autospace:none'>&#37096;&#21729;</p>
  </td>
  <td width=3D350 style=3D'width:262.5pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'text-align:center;punctua=
tion-wrap:
  simple;text-autospace:none'>&#25152;&#12288;&#12288;&#25484;&#12288;&#122=
88;&#20107;&#12288;&#12288;&#21209;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:solid windowtext=
 1.0pt;
  border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:s=
olid windowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#21508;&#29677;&#20849;&#36=
890;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#25152;&#25484;&#20107;&#38917;&#12=
395;&#38306;&#12377;&#12427;&#28797;&#23475;&#12398;&#24773;&#22577;&#21454=
;&#38598;&#21450;&#12403;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#=
12426;&#12414;&#12392;&#12417;&#21450;&#12403;&#24066;&#26412;&#37096;&#123=
92;&#12398;&#36899;&#32097;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;=
&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#25152;&#25=
484;&#20107;&#38917;&#12395;&#38306;&#12377;&#12427;&#28797;&#23475;&#12398=
;&#30330;&#29983;&#38450;&#31142;&#21448;&#12399;&#25313;&#22823;&#38450;&#=
27490;&#12398;&#12383;&#12417;&#12398;&#24540;&#24613;&#25514;&#32622;&#123=
95;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#20182;&#29=
677;&#12398;&#24540;&#25588;&#65288;&#34987;&#23475;&#35519;&#26619;&#31561=
;&#65289;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25152;&#25=
484;&#20107;&#38917;&#12395;&#38306;&#12377;&#12427;&#26045;&#35373;&#12289=
;&#35373;&#20633;&#12398;&#38450;&#35703;&#21450;&#12403;&#24540;&#24613;&#=
24489;&#26087;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65301;&#12288;&#25152;&#25484;&#20107;&#38917;&#12395;&#38306;&#12377;&#=
12427;&#32202;&#24613;&#32633;&#28797;&#35388;&#26126;&#12395;&#38306;&#123=
77;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:solid windowtext 1.0pt;
  border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:
  solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;mso-border=
-left-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#20225;&#30011;&#36001;=
&#25919;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>(</span>&=
#20225;&#30011;&#36001;&#25919;&#37096;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#32207;&#21209;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>(</span>&=
#32207;&#21209;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#32=
207;&#21209;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#26412;&#37096;&#20250;&#35696;&#12=
395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#27973;&#21=
475;&#24066;&#38450;&#28797;&#20250;&#35696;&#12392;&#12398;&#36899;&#32097=
;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#30476;&#26=
412;&#37096;&#21450;&#12403;&#38306;&#20418;&#27231;&#38306;&#22243;&#20307=
;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#24066;&#35=
696;&#20250;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#21508;&#37=
096;&#12395;&#12362;&#12369;&#12427;&#38450;&#28797;&#23550;&#31574;&#12398=
;&#32207;&#21512;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#38750;&#24=
120;&#25307;&#38598;&#21450;&#12403;&#38750;&#24120;&#37197;&#32622;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28797;&#23=
475;&#24540;&#24613;&#21450;&#12403;&#28797;&#23475;&#24489;&#26087;&#36027=
;&#12398;&#20104;&#31639;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#24066;&#26=
377;&#36001;&#29987;&#65288;&#20182;&#29677;&#12398;&#25152;&#31649;&#12395=
;&#23646;&#12377;&#12427;&#12418;&#12398;&#12434;&#38500;&#12367;&#12290;&#=
65289;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#12426;&#124=
14;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;=
</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#24193;&#33=
294;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#25226;&#25569;&#21450=
;&#12403;&#27231;&#33021;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#38651;&#35441;&#12395;&#12424;&#12427;&#36890;&#20449;&#36899;&#3=
2097;&#12398;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#26410;&#21033;&#29992;&#22320;&#12398;&#26222;&#36890;&#36001;&#2=
9987;&#65288;&#20182;&#29677;&#12398;&#25152;&#31649;&#12395;&#23646;&#1237=
7;&#12427;&#12418;&#12398;&#12434;&#38500;&#12367;&#12290;&#65289;&#12398;&=
#28797;&#23475;&#23550;&#31574;&#12398;&#12383;&#12417;&#12398;&#36024;&#20=
184;&#12369;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#26412;&#37096;&#38263;&#12398;&#21629;&#20196;&#20253;&#36948;&#2=
1450;&#12403;&#21508;&#37096;&#12392;&#12398;&#36899;&#32097;&#35519;&#2597=
2;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#33258;&#34907;&#38538;&#12395;&#23550;&#12377;&#12427;&#24773;&#2=
2577;&#36899;&#32097;&#21450;&#12403;&#28797;&#23475;&#27966;&#36963;&#3520=
1;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#29694;&#22320;&#23550;&#31574;&#26412;&#37096;&#12395;&#38306;&#1=
2377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#28961;&#32218;&#36890;&#20449;&#26045;&#35373;&#12398;&#36939;&#2=
9992;&#21450;&#12403;&#36890;&#20449;&#36899;&#32097;&#12398;&#30906;&#2044=
5;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#32202;&#24613;&#36890;&#34892;&#36554;&#20001;&#12398;&#30906;&#3=
5469;&#21450;&#12403;&#35388;&#31080;&#12398;&#30330;&#34892;&#12395;&#3830=
6;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>17</span>=
&#12288;&#24540;&#25588;&#21332;&#23450;&#12395;&#22522;&#12389;&#12367;&#2=
7966;&#36963;&#12398;&#35201;&#35531;&#21450;&#12403;&#21463;&#20837;&#1242=
8;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>18</span>=
&#12288;&#27671;&#35937;&#20104;&#22577;&#12289;&#38632;&#37327;&#12289;&#2=
7700;&#20301;&#31561;&#12398;&#24773;&#22577;&#21454;&#38598;&#12289;&#2025=
3;&#36948;&#21450;&#12403;&#35352;&#37682;&#12395;&#38306;&#12377;&#12427;&=
#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<span lang=3DEN-US style=3D'font-size:10.5pt;mso-bidi-font-size:10.0pt;font=
-family:
"MS Mincho";mso-hansi-font-family:"Courier New";mso-bidi-font-family:"Times=
 New Roman";
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:JA;
mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-character:lin=
e-break;
page-break-before:always'>
</span>

<p class=3DMsoPlainText style=3D'line-height:1.0pt;mso-line-height-rule:exa=
ctly;
punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;=
</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D3 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
  border-top:none;mso-border-left-alt:solid windowtext .5pt;mso-border-bott=
om-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US
  style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'><o:=
p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>19</span>&#12288;&#36991;&#38627;=
&#12398;&#35336;&#30011;&#12289;&#21223;&#21578;&#21450;&#12403;&#25351;&#3=
1034;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#20225;&#30011;&#25=
391;&#33288;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#20225;&#30011;&#25=
391;&#33288;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#20=
225;&#30011;&#25391;&#33288;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#26412;&#37096;&#38263;&#21450;&#12=
403;&#21103;&#26412;&#37096;&#38263;&#12398;&#31192;&#26360;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#12408;&#12398;&#24195=
;&#22577;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#28797;&#23=
475;&#20889;&#30495;&#12398;&#25774;&#24433;&#12381;&#12398;&#20182;&#28797=
;&#23475;&#12395;&#38306;&#12377;&#12427;&#24195;&#22577;&#36039;&#26009;&#=
12398;&#21454;&#38598;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#22577;&#36=
947;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#65315;&#65=
313;&#65332;&#65334;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290=
;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#28797;&#23=
475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#30456;&#35527;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28797;&#23=
475;&#12508;&#12521;&#12531;&#12486;&#12451;&#12450;&#12395;&#38306;&#12377=
;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#29983;&#27=
963;&#20132;&#36890;&#20307;&#31995;&#12398;&#30906;&#20445;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#32202;&#24=
613;&#36664;&#36865;&#12398;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427=
;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  lang=3DEN-US>10</span>&#12288;&#24066;&#12507;&#12540;&#12512;&#12506;&#1=
2540;&#12472;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;page-break-inside:avoid;height:49.3pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:49.3pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#24773;&#22577;&#25=
919;&#31574;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#24773;&#22577;&#25=
919;&#31574;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:49.3pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#24773;&#22577;&#25=
919;&#31574;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:49.3pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#28797;&#23475;&#26178;&#12395;&#12=
362;&#12369;&#12427;&#38651;&#31639;&#12471;&#12473;&#12486;&#12512;&#12398=
;&#27231;&#33021;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.7pt;text-indent:-10.7pt;mso-char-indent-count:-1.02;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65298;&#12288;&#28797;&#23475;&#26178;&#12395;&#12=
362;&#12369;&#12427;&#24773;&#22577;&#12493;&#12483;&#12488;&#12527;&#12540=
;&#12463;&#12398;&#27231;&#33021;&#30906;&#20445;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;page-break-inside:avoid'>
  <td width=3D84 rowspan=3D3 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid windowt=
ext .5pt;
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owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#29983;&#27963;&#29872;=
&#22659;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#29983;&#27963;&#29=
872;&#22659;&#37096;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#31246;&#21209;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#31246;&#21209;&#35=
506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#31=
246;&#21209;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#24066;&#31246;&#21450;&#12403;&#20171;&#35703;&#20445;&#38522;&#26009=
;&#12398;&#28187;&#38989;&#21448;&#12399;&#20813;&#38500;&#25514;&#32622;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#24066;&#27665;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'>&#65288;&#24066;&#27665;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#24=
066;&#27665;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#25937;&#35703;&#25152;&#12289;&#36=
991;&#38627;&#25152;&#12398;&#38283;&#35373;&#21450;&#12403;&#31649;&#29702=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#12395;&#12424;&#12427;&#29344;&#29298;&#32773;&#12398;&#22475;&#28779=
;&#33900;&#25163;&#32154;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#24180;&#37329;&#20445;&#38522=
;&#26009;&#12398;&#20813;&#38500;&#21463;&#20184;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522=
;&#34987;&#20445;&#38522;&#32773;&#35388;&#12398;&#20877;&#20132;&#20184;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522=
;&#19968;&#37096;&#36000;&#25285;&#37329;&#12398;&#28187;&#38989;&#21448;&#=
12399;&#20813;&#38500;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#123=
71;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65302;&#12288;&#30274;&#39178;&#21462;&#25201;&#27=
231;&#38306;&#12381;&#12398;&#20182;&#38306;&#20418;&#22243;&#20307;&#12392=
;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:5;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#29872;&#22659;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#29872;&#22659;&#35=
506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#29=
872;&#22659;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#34987;&#28797;&#22320;&#12395;&#12=
362;&#12369;&#12427;&#24259;&#26820;&#29289;&#12398;&#21454;&#38598;&#21450=
;&#12403;&#28165;&#25475;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#26178;&#12395;&#12362;&#12369;&#12427;&#12400;&#12356;&#29017;&#12289=
;&#26377;&#23475;&#29289;&#36074;&#31561;&#12398;&#28431;&#27945;&#31561;&#=
12395;&#23550;&#12377;&#12427;&#25514;&#32622;&#12395;&#38306;&#12377;&#124=
27;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#12362;&#12369;&#12427;&#27972;&#21270;&#27133;&#12398=
;&#31649;&#29702;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65300;&#12288;&#27515;&#20129;&#30044;&#29539;&#31561;&#12398;&#20966;&#=
29702;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:6;mso-yfti-lastrow:yes;page-break-inside:avoid;
  height:57.0pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:solid windowtext=
 1.0pt;
  border-bottom:none;mso-border-top-alt:solid windowtext .5pt;mso-border-le=
ft-alt:
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  0mm 4.95pt 0mm 4.95pt;height:57.0pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#20581;&#24247;&#31119;=
&#31049;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#20581;&#24247;&#31=
119;&#31049;&#37096;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
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text .5pt;
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owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#31038;&#20250;&#31=
119;&#31049;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#31038;&#20250;&#31=
119;&#31049;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
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text .5pt;
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owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#31=
038;&#20250;&#31119;&#31049;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:solid wind=
owtext 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
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owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#28=
797;&#23475;&#25937;&#21161;&#27861;&#36969;&#29992;&#20107;&#21209;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#32681;&#25588;&#37329;&#21450;&#12403;&#32681;&#25588;&#29289;&#36039=
;&#12398;&#21463;&#20184;&#12289;&#37197;&#20998;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left;line-height:1.0p=
t;
mso-line-height-rule:exactly'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
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  height:66.25pt'>
  <td width=3D84 rowspan=3D4 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
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om-alt:
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  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US
  style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'><o:=
p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
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  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbs=
p;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
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  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
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wtext .5pt;
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ndowtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#26085;&#26=
412;&#36196;&#21313;&#23383;&#31038;&#21450;&#12403;&#31038;&#20250;&#31119=
;&#31049;&#21332;&#35696;&#20250;&#12392;&#12398;&#36899;&#32097;&#35519;&#=
25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25937;&#25=
588;&#29289;&#36039;&#12398;&#35201;&#35531;&#21450;&#12403;&#35519;&#36948=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#24340;&#24944;&#37329;&#21450;&#12403;&#35211;&#33310;&#37329;&#21697=
;&#12398;&#25903;&#32102;&#31561;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#28797;&#23=
475;&#26178;&#35201;&#25588;&#35703;&#32773;&#12398;&#20445;&#35703;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:16.2pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65303;&#12288;&#38556;&#23475;&#32773;&#26045;&#35373;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23376;&#32946;&#12=
390;&#25903;&#25588;&#29677;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:16.2pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65288;&#23376;&#32946;&#12390;&#25903;&#25588;&#35506;&#38263;&#65289;</=
p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#23=
376;&#32946;&#12390;&#25903;&#25588;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#20445;&#32=
946;&#24188;&#20816;&#12398;&#23433;&#20840;&#12395;&#38306;&#12377;&#12427=
;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#24188;&#20816;&#12398;&#20445;&#32946;&#26009;&#12398;&#28187;&#38989=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#20816;&#31=
461;&#31119;&#31049;&#26045;&#35373;&#12395;&#38306;&#12377;&#12427;&#12371=
;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#39640;&#40802;&#32=
773;&#25903;&#25588;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#39640;&#40802;&#32=
773;&#25903;&#25588;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#39=
640;&#40802;&#32773;&#25903;&#25588;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#39=
640;&#40802;&#32773;&#12398;&#23433;&#20840;&#12395;&#38306;&#12377;&#12427=
;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#39640;&#40=
802;&#32773;&#31119;&#31049;&#26045;&#35373;&#12395;&#38306;&#12377;&#12427=
;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#20171;&#35703;&#20445;&#38522;&#34987;&#20445=
;&#38522;&#32773;&#35388;&#31561;&#12398;&#20877;&#20132;&#20184;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:16.2pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65300;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#20171;&#35703;&#20445;&#38522;&#19968;&#37096;&#36000;&#25285;&#37329=
;&#12398;&#28187;&#38989;&#21448;&#12399;&#20813;&#38500;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;page-break-inside:avoid;height:134.75pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:134.75pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#20581;&#24247;&#25=
512;&#36914;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#20581;&#24247;&#25=
512;&#36914;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:134.75pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#20=
581;&#24247;&#25512;&#36914;&#35506;&#21729;</p>
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  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:134.75pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#34=
987;&#28797;&#32773;&#12398;&#20581;&#24247;&#30456;&#35527;&#12289;&#24515=
;&#12398;&#12465;&#12450;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#12362;&#12369;&#12427;&#33256;&#26178;&#20104;&#38450=
;&#25509;&#31278;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#34987;&#28=
797;&#32773;&#12398;&#26628;&#39178;&#25351;&#23566;&#12289;&#39135;&#29983=
;&#27963;&#25913;&#21892;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#=
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  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#24863;&#26=
579;&#30151;&#20104;&#38450;&#12398;&#12383;&#12417;&#12398;&#38450;&#30123=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#21307;&#30=
274;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#21450;&#12403;&#21332=
;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#24540;&#24=
613;&#25937;&#21161;&#29992;&#21307;&#34220;&#21697;&#12381;&#12398;&#20182=
;&#21307;&#30274;&#36039;&#26448;&#12398;&#30906;&#20445;&#21450;&#12403;&#=
35036;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:16.2pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65303;&#12288;&#34987;&#28797;&#20663;&#30149;&#32=
773;&#12398;&#32202;&#24613;&#25937;&#35703;&#12395;&#38306;&#12377;&#12427=
;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4;page-break-inside:avoid'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid windowt=
ext .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#29987;&#26989;&#24314;=
&#35373;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#29987;&#26989;&#24=
314;&#35373;&#37096;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#29987;&#26989;&#25=
391;&#33288;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#29987;&#26989;&#25=
391;&#33288;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.2pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#29=
987;&#26989;&#25391;&#33288;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:16.2pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#23665;&#26519;&#12289;&#27835;&#27=
700;&#26045;&#35373;&#21450;&#12403;&#26519;&#36947;&#12398;&#38450;&#28797=
;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.2pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#36786;&#36=
947;&#12289;&#36786;&#26989;&#29992;&#27700;&#36335;&#12289;&#12383;&#12417=
;&#27744;&#21450;&#12403;&#25562;&#27700;&#26045;&#35373;&#31561;&#12398;&#=
38450;&#28797;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#123=
95;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#20013;&#23=
567;&#20225;&#26989;&#12395;&#23550;&#12377;&#12427;&#34701;&#36039;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#30149;&#23475;&#20104;&#38450;&#21450;&#12403;&#25216=
;&#34899;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#24540;&#24613;&#39135;&#31975;&#12398;&#30906;&#20445;&#21450;&#12403=
;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#34987;&#23475;&#29366;&#31069;&#12398;&#21462;&#12426=
;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#35251;&#20=
809;&#26045;&#35373;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462=
;&#12426;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.2pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#23478;&#30=
044;&#12398;&#38450;&#30123;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392=
;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:16.2pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65305;&#12288;&#22679;&#39178;&#27542;&#26045;&#35=
373;&#12289;&#20849;&#21516;&#21033;&#29992;&#26045;&#35373;&#12289;&#27700=
;&#29987;&#29289;&#28417;&#20855;&#12289;&#28417;&#33337;&#21450;&#12403;&#=
28417;&#28207;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#124=
26;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;=
&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:5;mso-yfti-lastrow:yes;page-break-inside:avoid;
  height:55.5pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
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owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#24314;&#35373;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#24314;&#35373;&#35=
506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
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text .5pt;
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owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#24=
314;&#35373;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:solid wind=
owtext 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#36947;&#36335;&#12289;&#27211;&#12=
426;&#12423;&#12358;&#12289;&#27827;&#24029;&#12381;&#12398;&#20182;&#22303=
;&#26408;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987;&#=
23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#12362;&#12369;&#12427;&#36947;&#36335;&#20132;&#36890=
;&#12398;&#31105;&#27490;&#21450;&#12403;&#21046;&#38480;&#12395;&#38306;&#=
12377;&#12427;</p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left;line-height:1.0p=
t;
mso-line-height-rule:exactly'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
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  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
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  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
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  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbs=
p;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
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  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
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  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
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y;
  punctuation-wrap:simple;text-autospace:none'>&#12288;&#12371;&#12392;&#12=
290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#27700;&#38=
450;&#27963;&#21205;&#12395;&#12362;&#12369;&#12427;&#20225;&#30011;&#12289=
;&#29366;&#27841;&#21028;&#26029;&#12289;&#32202;&#24613;&#23550;&#31574;&#=
21450;&#12403;&#25216;&#34899;&#25351;&#23566;&#12395;&#38306;&#12377;&#124=
27;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#27700;&#38=
450;&#36039;&#27231;&#26448;&#12398;&#30906;&#20445;&#12395;&#38306;&#12377=
;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#24540;&#24=
613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#29992;&#22320;&#30906=
;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#22303;&#26=
408;&#24314;&#31689;&#26989;&#32773;&#12395;&#23550;&#12377;&#12427;&#36899=
;&#32097;&#35519;&#25972;&#21450;&#12403;&#21332;&#21147;&#35201;&#35531;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65303;&#12288;&#36554;&#20001;&#12398;&#37197;&#36554;&#21450;&#12403;&#=
20511;&#29992;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37117;&#24066;&#35=
336;&#30011;&#29677;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65288;&#37117;&#24066;&#35336;&#30011;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#37=
117;&#24066;&#35336;&#30011;&#35506;&#21729;</p>
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  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#24=
540;&#24613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#24314;&#35373=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#20844;&#22=
290;&#31561;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987;&#23475;&#35519=
;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;page-break-inside:avoid'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
  border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:s=
olid windowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#19978;&#19979;&#27700;=
&#36947;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#19978;&#19979;&#27=
700;&#36947;&#37096;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
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text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#27700;&#36947;&#29=
677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#27700;&#36947;&#35=
506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#27=
700;&#36947;&#35506;&#21729;</p>
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  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#27=
700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987=
;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#23550;&#12377;&#12427;&#39154;&#26009;&#27700;&#12398=
;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#27700;&#36=
947;&#26045;&#35373;&#12398;&#24540;&#24613;&#24489;&#26087;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#34987;&#28=
797;&#22320;&#12398;&#27700;&#36947;&#26009;&#37329;&#12398;&#24500;&#21454=
;&#29494;&#20104;&#21450;&#12403;&#28187;&#38989;&#21448;&#12399;&#20813;&#=
38500;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65301;&#12288;&#27700;&#36947;&#38306;&#20418;&#12=
398;&#28797;&#23475;&#24540;&#24613;&#23550;&#31574;&#36027;&#12398;&#20104=
;&#31639;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#19979;&#27700;&#36=
947;&#29677;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65288;&#19979;&#27700;&#36947;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#26412;&#24193;&#19=
979;&#27700;&#36947;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#19=
979;&#27700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403=
;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#19979;&#27=
700;&#36947;&#26045;&#35373;&#12398;&#24540;&#24613;&#24489;&#26087;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4;page-break-inside:avoid'>
  <td width=3D84 rowspan=3D3 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid windowt=
ext .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;text-align:justify;text=
-justify:
  distribute-all-lines;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'font-family:"=
MS Gothic";
  mso-hansi-font-family:"Courier New"'>&#25945;&#32946;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#25945;&#32946;&#27=
425;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23398;&#26657;&#25=
945;&#32946;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#23398;&#26657;&#25=
945;&#32946;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23398;&#26657;&#25=
945;&#32946;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#20=
816;&#31461;&#29983;&#24466;&#12398;&#36991;&#38627;&#35336;&#30011;&#21450=
;&#12403;&#25351;&#31034;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12398;&#20816;&#31461;&#29983;&#24466;&#31561;&#12398;&#23601=
;&#23398;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#23398;&#26=
657;&#25945;&#32946;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403=
;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25945;&#32=
946;&#26045;&#35373;&#12398;&#32202;&#24613;&#20351;&#29992;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#36991;&#38=
627;&#25152;&#12398;&#35373;&#32622;&#21450;&#12403;&#31649;&#29702;&#12395=
;&#12388;&#12356;&#12390;&#12398;&#24540;&#25588;&#21332;&#21147;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65302;&#12288;&#38750;&#24120;&#28810;&#12365;&#20986;&#12375;&#23455;&#=
26045;&#26178;&#12395;&#12362;&#12369;&#12427;&#21332;&#21147;&#12395;&#383=
06;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:5;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#22269;&#38555;&#25=
991;&#21270;&#20132;&#27969;&#29677;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65288;&#22269;&#38555;&#25991;&#21270;&#20132;&#27969;&#35506;&#38263;&#=
65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#22269;&#38555;&#25=
991;&#21270;&#20132;&#27969;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#25=
991;&#21270;&#36001;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987;&#23475=
;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:6;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#29983;&#28079;&#23=
398;&#32722;&#29677;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65288;&#29983;&#28079;&#23398;&#32722;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#29983;&#28079;&#23=
398;&#32722;&#35506;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#31=
038;&#20250;&#25945;&#32946;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450=
;&#12403;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65298;&#12288;&#31038;&#20250;&#25945;&#32946;&#22=
243;&#20307;&#31561;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#21450=
;&#12403;&#21332;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:7;mso-yfti-lastrow:yes'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:solid windowtext=
 1.0pt;
  border-bottom:none;mso-border-top-alt:solid windowtext .5pt;mso-border-le=
ft-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#24540;&#25588;&#21332;=
&#21147;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#35696;&#20250;&#20=
107;&#21209;&#23616;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#24540;&#25588;&#21=
332;&#21147;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#20250;&#35336;&#35=
506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#35696;&#20250;&#20=
107;&#21209;&#23616;&#21729;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#20250;&#35336;&#35506;&#21=
729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:solid wind=
owtext 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
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owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#20=
182;&#29677;&#12398;&#24540;&#25588;&#21332;&#21147;&#12395;&#38306;&#12377=
;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left;line-height:1.0p=
t;
mso-line-height-rule:exactly'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
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 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
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ft-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#37329;&#20809;&#32207;=
&#21512;&#25903;&#25152;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:solid windowtext=
 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:solid windowtext=
 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:solid windowte=
xt 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#26412;&#24193;&#21450;&#12403;&#38=
306;&#20418;&#27231;&#38306;&#22243;&#20307;&#12392;&#12398;&#36899;&#32097=
;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#32207;&#21=
512;&#25903;&#25152;&#21508;&#29677;&#12395;&#12362;&#12369;&#12427;&#38450=
;&#28797;&#23550;&#31574;&#12398;&#32207;&#21512;&#35519;&#25972;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#24066;&#26=
377;&#36001;&#29987;&#65288;&#20182;&#29677;&#12398;&#25152;&#31649;&#12395=
;&#23646;&#12377;&#12427;&#12418;&#12398;&#12434;&#38500;&#12367;&#12290;&#=
65289;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#12426;&#124=
14;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;=
</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#24193;&#33=
294;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#25226;&#25569;&#21450=
;&#12403;&#27231;&#33021;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#38651;&#35=
441;&#12395;&#12424;&#12427;&#36890;&#20449;&#36899;&#32097;&#12398;&#30906=
;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#26410;&#21=
033;&#29992;&#22320;&#12398;&#26222;&#36890;&#36001;&#29987;&#65288;&#20182=
;&#29677;&#12398;&#25152;&#31649;&#12395;&#23646;&#12377;&#12427;&#12418;&#=
12398;&#12434;&#38500;&#12367;&#12290;&#65289;&#12398;&#28797;&#23475;&#235=
50;&#31574;&#12398;&#12383;&#12417;&#12398;&#36024;&#20184;&#12369;&#12395;=
&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28961;&#32=
218;&#36890;&#20449;&#26045;&#35373;&#12398;&#36939;&#29992;&#21450;&#12403=
;&#36890;&#20449;&#36899;&#32097;&#12398;&#30906;&#20445;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#27671;&#35=
937;&#20104;&#22577;&#12289;&#38632;&#37327;&#12289;&#27700;&#20301;&#31561=
;&#12398;&#24773;&#22577;&#21454;&#38598;&#12289;&#20253;&#36948;&#21450;&#=
12403;&#35352;&#37682;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#36991;&#38=
627;&#12398;&#35336;&#30011;&#12289;&#21223;&#21578;&#21450;&#12403;&#25351=
;&#31034;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#1=
2408;&#12398;&#24195;&#22577;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#28797;&#23475;&#20889;&#30495;&#12398;&#25774;&#24433;&#12381;&#1=
2398;&#20182;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#24195;&#2257=
7;&#36039;&#26009;&#12398;&#21454;&#38598;&#12395;&#38306;&#12377;&#12427;&=
#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#22577;&#36947;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#3=
5519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#65315;&#65313;&#65332;&#65334;&#12395;&#38306;&#12377;&#12427;&#1=
2371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#3=
0456;&#35527;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#28797;&#23475;&#12508;&#12521;&#12531;&#12486;&#12451;&#12450;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#29983;&#27963;&#20132;&#36890;&#20307;&#31995;&#12398;&#30906;&#2=
0445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  lang=3DEN-US>17</span>&#12288;&#32202;&#24613;&#36664;&#36865;&#12398;&#3=
0906;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#22659;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#22659;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#22659;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#24066;&#31246;&#21450;&#12403;&#20171;&#35703;&#20445;&#38522;&#26009=
;&#12398;&#28187;&#38989;&#21448;&#12399;&#20813;&#38500;&#25514;&#32622;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#25937;&#35=
703;&#25152;&#12289;&#36991;&#38627;&#25152;&#12398;&#38283;&#35373;&#21450=
;&#12403;&#31649;&#29702;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#28797;&#23=
475;&#12395;&#12424;&#12427;&#29344;&#29298;&#32773;&#12398;&#22475;&#28779=
;&#33900;&#25163;&#32154;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#24180;&#37329;&#20445;&#38522=
;&#26009;&#12398;&#20813;&#38500;&#21463;&#20184;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522=
;&#34987;&#20445;&#38522;&#32773;&#35388;&#12398;&#20877;&#20132;&#20184;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#28797;&#23=
475;&#12395;&#20276;&#12358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522=
;&#19968;&#37096;&#36000;&#25285;&#37329;&#12398;&#28187;&#38989;&#21448;&#=
12399;&#20813;&#38500;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#123=
71;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#30274;&#39=
178;&#21462;&#25201;&#27231;&#38306;&#12381;&#12398;&#20182;&#38306;&#20418=
;&#22243;&#20307;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#12362;&#12369;&#12427;&#24259;&#26820;&#29289;&#12398=
;&#21454;&#38598;&#21450;&#12403;&#28165;&#25475;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-align:justify;
  text-justify:distribute-all-lines;text-indent:-10.5pt;mso-char-indent-cou=
nt:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65305;&#12288;&#28797;&#23475;&#26178;&#12395;&#12=
362;&#12369;&#12427;&#12400;&#12356;&#29017;&#12289;&#26377;&#27602;&#12460=
;&#12473;&#12289;&#26377;&#23475;&#29289;&#36074;&#31561;&#12398;</p>
  </td>
 </tr>
</table>

<span lang=3DEN-US style=3D'font-size:10.5pt;mso-bidi-font-size:10.0pt;font=
-family:
"MS Mincho";mso-hansi-font-family:"Courier New";mso-bidi-font-family:"Times=
 New Roman";
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:JA;
mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-character:lin=
e-break;
page-break-before:always'>
</span>

<p class=3DMsoPlainText style=3D'line-height:1.0pt;mso-line-height-rule:exa=
ctly;
punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;=
</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D3 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#12288;&#28431;&#27945;&#31=
561;&#12395;&#23550;&#12377;&#12427;&#25514;&#32622;&#12395;&#38306;&#12377=
;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#27972;&#2=
1270;&#27133;&#12398;&#31649;&#29702;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#27515;&#20129;&#30044;&#29539;&#31561;&#12398;&#20966;&#29702;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>12</span>&#12288;&#24863;&#26579;=
&#30151;&#20104;&#38450;&#12398;&#12383;&#12417;&#12398;&#38450;&#30123;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid;height:373.05pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:373.05pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:373.05pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt;
  height:373.05pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#28=
797;&#23475;&#25937;&#21161;&#27861;&#36969;&#29992;&#20107;&#21209;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#32681;&#25588;&#37329;&#21450;&#12403;&#32681;&#25588;&#29289;&#36039=
;&#12398;&#21463;&#20184;&#12289;&#37197;&#20998;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#26085;&#26=
412;&#36196;&#21313;&#23383;&#31038;&#21450;&#12403;&#31038;&#20250;&#31119=
;&#31049;&#21332;&#35696;&#20250;&#12392;&#12398;&#36899;&#32097;&#35519;&#=
25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25937;&#25=
588;&#29289;&#36039;&#12398;&#35201;&#35531;&#21450;&#12403;&#35519;&#36948=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#21307;&#30=
274;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#21450;&#12403;&#21332=
;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#24540;&#24=
613;&#25937;&#21161;&#29992;&#21307;&#34220;&#21697;&#12381;&#12398;&#20182=
;&#21307;&#30274;&#36039;&#26448;&#12398;&#30906;&#20445;&#21450;&#12403;&#=
35036;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28797;&#23=
475;&#24340;&#24944;&#37329;&#21450;&#12403;&#35211;&#33310;&#37329;&#21697=
;&#12398;&#25903;&#32102;&#31561;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#28797;&#23=
475;&#26178;&#35201;&#25588;&#35703;&#32773;&#12398;&#20445;&#35703;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#34987;&#28=
797;&#20663;&#30149;&#32773;&#12398;&#32202;&#24613;&#25937;&#35703;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#20445;&#32946;&#24188;&#20816;&#12398;&#23433;&#20840;&#12395;&#3=
8306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#34987;&#28797;&#24188;&#20816;&#12398;&#20445;&#32946;&#26009;&#1=
2398;&#28187;&#38989;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#1229=
0;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#20816;&#31461;&#31119;&#31049;&#26045;&#35373;&#21450;&#12403;&#3=
8556;&#23475;&#32773;&#26045;&#35373;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#39640;&#40802;&#32773;&#12398;&#23433;&#20840;&#12395;&#38306;&#1=
2377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#39640;&#40802;&#32773;&#31119;&#31049;&#26045;&#35373;&#12395;&#3=
8306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#28797;&#23475;&#12395;&#20276;&#12358;&#20171;&#35703;&#20445;&#3=
8522;&#34987;&#20445;&#38522;&#32773;&#35388;&#31561;&#12398;&#20877;&#2013=
2;&#20184;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#28797;&#23475;&#12395;&#20276;&#12358;&#20171;&#35703;&#20445;&#3=
8522;&#19968;&#37096;&#36000;&#25285;&#37329;&#12398;&#28187;&#38989;&#2144=
8;&#12399;&#20813;&#38500;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&=
#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>17</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#33256;&#2=
6178;&#20104;&#38450;&#25509;&#31278;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>18</span>&#12288;&#34987;&#28797;=
&#32773;&#12398;&#26628;&#39178;&#25351;&#23566;&#12289;&#39135;&#29983;&#2=
7963;&#25913;&#21892;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29987;&#26989;&#24314;&#35373;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29987;&#26989;&#24314;&#35373;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#29987;&#26989;&#24314;&#35373;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#23665;&#26519;&#12289;&#27835;&#27=
700;&#26045;&#35373;&#21450;&#12403;&#26519;&#36947;&#12398;&#38450;&#28797=
;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#36786;&#36=
947;&#12289;&#36786;&#26989;&#29992;&#27700;&#36335;&#12289;&#12383;&#12417=
;&#27744;&#21450;&#12403;&#25562;&#27700;&#26045;&#35373;&#31561;&#12398;&#=
38450;&#28797;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#123=
95;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#20013;&#23=
567;&#20225;&#26989;&#12395;&#23550;&#12377;&#12427;&#34701;&#36039;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#30149;&#23475;&#20104;&#38450;&#21450;&#12403;&#25216=
;&#34899;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#24540;&#24613;&#39135;&#31975;&#12398;&#30906;&#20445;&#21450;&#12403=
;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#12426=
;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#35251;&#20=
809;&#26045;&#35373;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462=
;&#12426;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#23478;&#30=
044;&#12398;&#38450;&#30123;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392=
;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#36947;&#36=
335;&#12289;&#27211;&#12426;&#12423;&#12358;&#12289;&#27827;&#24029;&#12381=
;&#12398;&#20182;&#22303;&#26408;&#26045;&#35373;&#12398;&#38450;&#28797;&#=
21450;&#12403;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#124=
27;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<span lang=3DEN-US style=3D'font-size:10.5pt;mso-bidi-font-size:10.0pt;font=
-family:
"MS Mincho";mso-hansi-font-family:"Courier New";mso-bidi-font-family:"Times=
 New Roman";
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:JA;
mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-character:lin=
e-break;
page-break-before:always'>
</span>

<p class=3DMsoPlainText style=3D'line-height:1.0pt;mso-line-height-rule:exa=
ctly;
punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;=
</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D3 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
  border-top:none;mso-border-left-alt:solid windowtext .5pt;mso-border-bott=
om-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#36947;&#3=
6335;&#20132;&#36890;&#12398;&#31105;&#27490;&#21450;&#12403;&#21046;&#3848=
0;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#27700;&#38450;&#27963;&#21205;&#12395;&#12362;&#12369;&#12427;&#2=
0225;&#30011;&#12289;&#29366;&#27841;&#21028;&#26029;&#12289;&#32202;&#2461=
3;&#23550;&#31574;&#21450;&#12403;&#25216;&#34899;&#25351;&#23566;&#12395;&=
#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#27700;&#38450;&#36039;&#27231;&#26448;&#12398;&#30906;&#20445;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#24540;&#24613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#2=
9992;&#22320;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#22303;&#26408;&#24314;&#31689;&#26989;&#32773;&#12395;&#23550;&#1=
2377;&#12427;&#36899;&#32097;&#35519;&#25972;&#21450;&#12403;&#21332;&#2114=
7;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;<=
/p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#36554;&#20001;&#12398;&#37197;&#36554;&#21450;&#12403;&#20511;&#2=
9992;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#24540;&#24613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#2=
4314;&#35373;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>17</span>&#12288;&#20844;&#22290;=
&#31561;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987;&#23475;&#35519;&#2=
6619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#19978;&#19979;&#27700;&#36947;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#19978;&#19979;&#27700;&#36947;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#32=
207;&#21512;&#25903;&#25152;&#19978;&#19979;&#27700;&#36947;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#27=
700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987=
;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12395;&#23550;&#12377;&#12427;&#39154;&#26009;&#27700;&#12398=
;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#27700;&#36=
947;&#26045;&#35373;&#12398;&#24540;&#24613;&#24489;&#26087;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#34987;&#28=
797;&#22320;&#12398;&#27700;&#36947;&#26009;&#37329;&#12398;&#24500;&#21454=
;&#29494;&#20104;&#21450;&#12403;&#28187;&#38989;&#21448;&#12399;&#20813;&#=
38500;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#19979;&#27=
700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987=
;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65302;&#12288;&#19979;&#27700;&#36947;&#26045;&#35373;&#12398;&#24540;&#=
24613;&#24489;&#26087;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#37329;&#20809;&#25=
945;&#32946;&#29677;&#65288;&#25945;&#32946;&#22996;&#21729;&#20250;&#37329=
;&#20809;&#20998;&#23460;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#25945;&#32946;&#22=
996;&#21729;&#20250;&#37329;&#20809;&#20998;&#23460;&#21729;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#20=
816;&#31461;&#29983;&#24466;&#12398;&#36991;&#38627;&#35336;&#30011;&#21450=
;&#12403;&#25351;&#31034;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#34987;&#28=
797;&#22320;&#12398;&#20816;&#31461;&#29983;&#24466;&#31561;&#12398;&#23601=
;&#23398;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#23398;&#26=
657;&#25945;&#32946;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403=
;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25945;&#32=
946;&#26045;&#35373;&#12398;&#32202;&#24613;&#20351;&#29992;&#12395;&#38306=
;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#36991;&#38=
627;&#25152;&#12398;&#35373;&#32622;&#21450;&#12403;&#31649;&#29702;&#12395=
;&#12388;&#12356;&#12390;&#12398;&#24540;&#25588;&#21332;&#21147;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#38750;&#24=
120;&#28810;&#12365;&#20986;&#12375;&#23455;&#26045;&#26178;&#12395;&#12362=
;&#12369;&#12427;&#21332;&#21147;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#25991;&#21=
270;&#36001;&#12398;&#38450;&#28797;&#21450;&#12403;&#34987;&#23475;&#35519=
;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#31038;&#20=
250;&#25945;&#32946;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403=
;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'>&#65305;&#12288;&#31038;&#20250;&#25945;&#32946;&#22=
243;&#20307;&#31561;&#12392;&#12398;&#36899;&#32097;&#35519;&#25972;&#21450=
;&#12403;&#21332;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:solid windowtext 1.0pt;
  border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:
  solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;mso-border=
-left-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-=
family:
  "MS Gothic";mso-hansi-font-family:"Courier New"'>&#23492;&#23798;&#32207;=
&#21512;&#25903;&#25152;&#37096;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  <p class=3DMsoPlainText style=3D'line-height:16.8pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#38263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:16.8pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#32207;&#21209;&#25391;&#33288;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:16.8pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#26412;&#24193;&#21450;&#12403;&#38=
306;&#20418;&#27231;&#38306;&#22243;&#20307;&#12392;&#12398;&#36899;&#32097=
;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.8pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#32207;&#21=
512;&#25903;&#25152;&#21508;&#29677;&#12395;&#12362;&#12369;&#12427;&#38450=
;&#28797;&#23550;&#31574;&#12398;&#32207;&#21512;&#35519;&#25972;&#12395;&#=
38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.8pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#24066;&#26=
377;&#36001;&#29987;&#65288;&#20182;&#29677;&#12398;&#25152;&#31649;&#12395=
;&#23646;&#12377;&#12427;&#12418;&#12398;&#12434;&#38500;&#12367;&#12290;&#=
65289;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#12426;&#124=
14;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;=
</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.8pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#24193;&#33=
294;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#25226;&#25569;&#21450=
;&#12403;&#27231;&#33021;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#38651;&#35=
441;&#12395;&#12424;&#12427;&#36890;&#20449;&#36899;&#32097;&#12398;&#30906=
;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:16.8pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#26410;&#21=
033;&#29992;&#22320;&#12398;&#26222;&#36890;&#36001;&#29987;&#65288;&#20182=
;&#29677;&#12398;&#25152;&#31649;&#12395;&#23646;&#12377;&#12427;&#12418;&#=
12398;&#12434;&#38500;&#12367;&#12290;&#65289;&#12398;&#28797;&#23475;&#235=
50;&#31574;&#12398;&#12383;&#12417;&#12398;&#36024;&#20184;&#12369;&#12395;=
&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<span lang=3DEN-US style=3D'font-size:10.5pt;mso-bidi-font-size:10.0pt;font=
-family:
"MS Mincho";mso-hansi-font-family:"Courier New";mso-bidi-font-family:"Times=
 New Roman";
mso-font-kerning:1.0pt;mso-ansi-language:EN-US;mso-fareast-language:JA;
mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-character:lin=
e-break;
page-break-before:always'>
</span>

<p class=3DMsoPlainText style=3D'line-height:1.0pt;mso-line-height-rule:exa=
ctly;
punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;=
</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US
  style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'><o:=
p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:16.8pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28961;&#32=
218;&#36890;&#20449;&#26045;&#35373;&#12398;&#36939;&#29992;&#21450;&#12403=
;&#36890;&#20449;&#36899;&#32097;&#12398;&#30906;&#20445;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#27671;&#35=
937;&#20104;&#22577;&#12289;&#38632;&#37327;&#12289;&#27700;&#20301;&#31561=
;&#12398;&#24773;&#22577;&#21454;&#38598;&#12289;&#20253;&#36948;&#21450;&#=
12403;&#35352;&#37682;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#122=
90;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#36991;&#38=
627;&#12398;&#35336;&#30011;&#12289;&#21223;&#21578;&#21450;&#12403;&#25351=
;&#31034;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#1=
2408;&#12398;&#24195;&#22577;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#28797;&#23475;&#20889;&#30495;&#12398;&#25774;&#24433;&#12381;&#1=
2398;&#20182;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#24195;&#2257=
7;&#36039;&#26009;&#12398;&#21454;&#38598;&#12395;&#38306;&#12377;&#12427;&=
#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#22577;&#36947;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#3=
5519;&#25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#65315;&#65313;&#65332;&#65334;&#12395;&#38306;&#12377;&#12427;&#1=
2371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#28797;&#23475;&#12395;&#38306;&#12377;&#12427;&#20303;&#27665;&#3=
0456;&#35527;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#28797;&#23475;&#12508;&#12521;&#12531;&#12486;&#12451;&#12450;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#29983;&#27963;&#20132;&#36890;&#20307;&#31995;&#12398;&#30906;&#2=
0445;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>17</span>&#12288;&#32202;&#24613;=
&#36664;&#36865;&#12398;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#1=
2371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#22659;&#29677;&#65288=
;&#23492;&#23798;&#32207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#=
22659;&#35506;&#38263;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#29983;&#27963;&#29872;&#22659;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#24066;&#31246;&#21450;&#12403;&#20171;&#35703;&#20445;&#38522;&#26009=
;&#12398;&#28187;&#38989;&#21448;&#12399;&#20813;&#38500;&#25514;&#32622;&#=
12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#25937;&#35=
703;&#25152;&#12289;&#36991;&#38627;&#25152;&#12398;&#38283;&#35373;&#21450=
;&#12403;&#31649;&#29702;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#28797;&#23=
475;&#12395;&#12424;&#12427;&#29344;&#29298;&#32773;&#12398;&#22475;&#28779=
;&#33900;&#25163;&#32154;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65300;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#22269;&#27665;&#24180;&#37329;&#20445;&#38522;&#26009;&#12398;&#20813=
;&#38500;&#21463;&#20184;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65301;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522;&#34987;&#20445;&#38522=
;&#32773;&#35388;&#12398;&#20877;&#20132;&#20184;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65302;&#12288;&#28797;&#23475;&#12395;&#20276;&#12=
358;&#22269;&#27665;&#20581;&#24247;&#20445;&#38522;&#19968;&#37096;&#36000=
;&#25285;&#37329;&#12398;&#28187;&#38989;&#21448;&#12399;&#20813;&#38500;&#=
25514;&#32622;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65303;&#12288;&#30274;&#39178;&#21462;&#25201;&#27=
231;&#38306;&#12381;&#12398;&#20182;&#38306;&#20418;&#22243;&#20307;&#12392=
;&#12398;&#36899;&#32097;&#35519;&#25972;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65304;&#12288;&#34987;&#28797;&#22320;&#12395;&#12=
362;&#12369;&#12427;&#24259;&#26820;&#29289;&#12398;&#21454;&#38598;&#21450=
;&#12403;&#28165;&#25475;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65305;&#12288;&#28797;&#23475;&#26178;&#12395;&#12=
362;&#12369;&#12427;&#12400;&#12356;&#29017;&#12289;&#26377;&#27602;&#12460=
;&#12473;&#12289;&#26377;&#23475;&#29289;&#36074;&#31561;&#12398;&#28431;&#=
27945;&#31561;&#12395;&#23550;&#12377;&#12427;&#25514;&#32622;&#12395;&#383=
06;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#27972;&#2=
1270;&#27133;&#12398;&#31649;&#29702;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#27515;&#20129;&#30044;&#29539;&#31561;&#12398;&#20966;&#29702;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  lang=3DEN-US>12</span>&#12288;&#24863;&#26579;&#30151;&#20104;&#38450;&#1=
2398;&#12383;&#12417;&#12398;&#38450;&#30123;&#12395;&#38306;&#12377;&#1242=
7;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;page-break-inside:avoid;
  height:85.5pt'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:solid windowtext 1.0pt;
  border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-left-al=
t:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt;height:85.5pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:85.5pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:solid window=
text 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:85.5pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#20581;&#24247;&#31119;&#31049;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:solid wind=
owtext 1.0pt;
  border-left:none;border-bottom:none;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-top-alt:solid window=
text .5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:85.5pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#28=
797;&#23475;&#25937;&#21161;&#27861;&#36969;&#29992;&#20107;&#21209;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#28797;&#23=
475;&#32681;&#25588;&#37329;&#21450;&#12403;&#32681;&#25588;&#29289;&#36039=
;&#12398;&#21463;&#20184;&#12289;&#37197;&#20998;&#12395;&#38306;&#12377;&#=
12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#26085;&#26=
412;&#36196;&#21313;&#23383;&#31038;&#21450;&#12403;&#31038;&#20250;&#31119=
;&#31049;&#21332;&#35696;&#20250;&#12392;&#12398;&#36899;&#32097;&#35519;&#=
25972;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#25937;&#25=
588;&#29289;&#36039;&#12398;&#35201;&#35531;&#21450;&#12403;&#35519;&#36948=
;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left;line-height:1.0p=
t;
mso-line-height-rule:exactly'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
  height:246.75pt'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border-top:=
none;
  border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid =
windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:246.75pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:246.75pt'>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbs=
p;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:246.75pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt;height:246.75pt'>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#21307;&#30=
274;&#27231;&#38306;&#12392;&#12398;&#36899;&#32097;&#21450;&#12403;&#21332=
;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#24540;&#24=
613;&#25937;&#21161;&#29992;&#21307;&#34220;&#21697;&#12381;&#12398;&#20182=
;&#21307;&#30274;&#36039;&#26448;&#12398;&#30906;&#20445;&#21450;&#12403;&#=
35036;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#28797;&#23=
475;&#24340;&#24944;&#37329;&#21450;&#12403;&#35211;&#33310;&#37329;&#21697=
;&#12398;&#25903;&#32102;&#31561;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#28797;&#23=
475;&#26178;&#35201;&#25588;&#35703;&#32773;&#12398;&#20445;&#35703;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#34987;&#28=
797;&#20663;&#30149;&#32773;&#12398;&#32202;&#24613;&#25937;&#35703;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#20445;&#32946;&#24188;&#20816;&#12398;&#23433;&#20840;&#12395;&#3=
8306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#34987;&#28797;&#24188;&#20816;&#12398;&#20445;&#32946;&#26009;&#1=
2398;&#28187;&#38989;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#1229=
0;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#20816;&#31461;&#31119;&#31049;&#26045;&#35373;&#21450;&#12403;&#3=
8556;&#23475;&#32773;&#26045;&#35373;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#39640;&#40802;&#32773;&#12398;&#23433;&#20840;&#12395;&#38306;&#1=
2377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#39640;&#40802;&#32773;&#31119;&#31049;&#26045;&#35373;&#12395;&#3=
8306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#28797;&#23475;&#12395;&#20276;&#12358;&#20171;&#35703;&#20445;&#3=
8522;&#34987;&#20445;&#38522;&#32773;&#35388;&#31561;&#12398;&#20877;&#2013=
2;&#20184;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#28797;&#23475;&#12395;&#20276;&#12358;&#20171;&#35703;&#20445;&#3=
8522;&#19968;&#37096;&#36000;&#25285;&#37329;&#12398;&#28187;&#38989;&#2144=
8;&#12399;&#20813;&#38500;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&=
#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>17</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#33256;&#2=
6178;&#20104;&#38450;&#25509;&#31278;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DEN-US>18</span>&#12288;&#34987;&#28797;=
&#32773;&#12398;&#26628;&#39178;&#25351;&#23566;&#12289;&#39135;&#29983;&#2=
7963;&#25913;&#21892;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#29987;&#26989;&#24314;&#35373;&#29677;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65288;&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#29987;&#26989;&#24314;&#35373;&#35506;&#38263=
;&#65289;</p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#23492;&#23798;&#32=
207;&#21512;&#25903;&#25152;&#24314;&#35373;&#29987;&#26989;&#35506;&#21729=
;</p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  0mm;margin-left:10.5pt;margin-bottom:.0001pt;text-indent:-10.5pt;mso-char=
-indent-count:
  -1.0;line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65297;&#12288;&#23665;&#26519;&#12289;&#27835;&#27=
700;&#26045;&#35373;&#21450;&#12403;&#26519;&#36947;&#12398;&#38450;&#28797=
;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#=
12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65298;&#12288;&#36786;&#36=
947;&#12289;&#36786;&#26989;&#29992;&#27700;&#36335;&#12289;&#12383;&#12417=
;&#27744;&#21450;&#12403;&#25562;&#27700;&#26045;&#35373;&#31561;&#12398;&#=
38450;&#28797;&#20006;&#12403;&#12395;&#34987;&#23475;&#35519;&#26619;&#123=
95;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65299;&#12288;&#20013;&#23=
567;&#20225;&#26989;&#12395;&#23550;&#12377;&#12427;&#34701;&#36039;&#12395=
;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65300;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#30149;&#23475;&#20104;&#38450;&#21450;&#12403;&#25216=
;&#34899;&#25351;&#23566;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65301;&#12288;&#28797;&#23=
475;&#24540;&#24613;&#39135;&#31975;&#12398;&#30906;&#20445;&#21450;&#12403=
;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</=
p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#36786;&#20=
316;&#29289;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462;&#12426=
;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#=
12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#35251;&#20=
809;&#26045;&#35373;&#12398;&#34987;&#23475;&#29366;&#27841;&#12398;&#21462=
;&#12426;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65304;&#12288;&#23478;&#30=
044;&#12398;&#38450;&#30123;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392=
;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'>&#65305;&#12288;&#22679;&#39=
178;&#27542;&#26045;&#35373;&#12289;&#20849;&#21516;&#21033;&#29992;&#26045=
;&#35373;&#12289;&#27700;&#29987;&#29289;&#28417;&#20855;&#12289;&#28417;&#=
33337;&#21450;&#12403;&#28417;&#28207;&#12398;&#34987;&#23475;&#29366;&#278=
41;&#12398;&#21462;&#12426;&#12414;&#12392;&#12417;&#12395;&#38306;&#12377;=
&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>10</span>=
&#12288;&#36947;&#36335;&#12289;&#27211;&#12426;&#12423;&#12358;&#12289;&#2=
7827;&#24029;&#12381;&#12398;&#20182;&#22303;&#26408;&#26045;&#35373;&#1239=
8;&#38450;&#28797;&#21450;&#12403;&#34987;&#23475;&#35519;&#26619;&#12395;&=
#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>11</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#12362;&#12369;&#12427;&#36947;&#3=
6335;&#20132;&#36890;&#12398;&#31105;&#27490;&#21450;&#12403;&#21046;&#3848=
0;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>12</span>=
&#12288;&#27700;&#38450;&#27963;&#21205;&#12395;&#12362;&#12369;&#12427;&#2=
0225;&#30011;&#12289;&#29366;&#27841;&#21028;&#26029;&#12289;&#32202;&#2461=
3;&#23550;&#31574;&#21450;&#12403;&#25216;&#34899;&#25351;&#23566;&#12395;&=
#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>13</span>=
&#12288;&#27700;&#38450;&#36039;&#27231;&#26448;&#12398;&#30906;&#20445;&#1=
2395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>14</span>=
&#12288;&#24540;&#24613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#2=
9992;&#22320;&#30906;&#20445;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>15</span>=
&#12288;&#22303;&#26408;&#24314;&#31689;&#26989;&#32773;&#12395;&#23550;&#1=
2377;&#12427;&#36899;&#32097;&#35519;&#25972;&#21450;&#12403;&#21332;&#2114=
7;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;<=
/p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left;line-height:1.0p=
t;
mso-line-height-rule:exactly'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid=
'>
  <td width=3D84 rowspan=3D2 valign=3Dtop style=3D'width:63.0pt;border:soli=
d windowtext 1.0pt;
  border-top:none;mso-border-left-alt:solid windowtext .5pt;mso-border-bott=
om-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:n=
one'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D70 valign=3Dtop style=3D'width:52.5pt;border-top:none;border-=
left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><=
o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D350 valign=3Dtop style=3D'width:262.5pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>16</span>=
&#12288;&#36554;&#20001;&#12398;&#37197;&#36554;&#21450;&#12403;&#20511;&#2=
9992;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>17</span>=
&#12288;&#24540;&#24613;&#20206;&#35373;&#20303;&#23429;&#31561;&#12398;&#2=
4314;&#35373;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>18</span>=
&#12288;&#20844;&#22290;&#31561;&#12398;&#38450;&#28797;&#21450;&#12403;&#3=
4987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#1239=
2;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>19</span>=
&#12288;&#27700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#1=
2403;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>20</span>=
&#12288;&#34987;&#28797;&#22320;&#12395;&#23550;&#12377;&#12427;&#39154;&#2=
6009;&#27700;&#12398;&#20379;&#32102;&#12395;&#38306;&#12377;&#12427;&#1237=
1;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>21</span>=
&#12288;&#27700;&#36947;&#26045;&#35373;&#12398;&#24540;&#24613;&#24489;&#2=
6087;&#12395;&#38306;&#12377;&#12427;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
  mso-char-indent-count:-1.0;line-height:17.0pt;mso-line-height-rule:exactl=
y;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>22</span>=
&#12288;&#34987;&#28797;&#22320;&#12398;&#27700;&#36947;&#26009;&#37329;&#1=
2398;&#24500;&#21454;&#29494;&#20104;&#21450;&#12403;&#28187;&#38989;&#2144=
8;&#12399;&#20813;&#38500;&#25514;&#32622;&#12395;&#38306;&#12377;&#12427;&=
#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US>23</span>=
&#12288;&#19979;&#27700;&#36947;&#26045;&#35373;&#12398;&#38450;&#28797;&#2=
1450;&#12403;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#1242=
7;&#12371;&#12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
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><span
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1;&#12392;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes;page-break-inside:avoid'>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
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  </td>
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left:none;
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line-height-rule:
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  </td>
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r-left:
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.0pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65297;&#12288;&#20=
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exactly;
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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  <p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;
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627;&#25152;&#12398;&#35373;&#32622;&#21450;&#12403;&#31649;&#29702;&#12395=
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65302;&#12288;&#38750;&#24=
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
  punctuation-wrap:simple;text-autospace:none'>&#65303;&#12288;&#25991;&#21=
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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250;&#25945;&#32946;&#26045;&#35373;&#12398;&#38450;&#28797;&#21450;&#12403=
;&#34987;&#23475;&#35519;&#26619;&#12395;&#38306;&#12377;&#12427;&#12371;&#=
12392;&#12290;</p>
  <p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-b=
ottom:
  4.0pt;margin-left:10.5pt;text-indent:-10.5pt;mso-char-indent-count:-1.0;
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;&#12403;&#21332;&#21147;&#35201;&#35531;&#12395;&#38306;&#12377;&#12427;&#=
12371;&#12392;&#12290;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
lang=3DEN-US><o:p>&nbsp;</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:15.45pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
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  <td width=3D98 valign=3Dtop style=3D'width:73.5pt;border:solid windowtext=
 1.0pt;
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  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:5.0pt;margin-r=
ight:0mm;
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mple;
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  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border:solid windowtext=
 1.0pt;
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ight:0mm;
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  <td width=3D406 valign=3Dtop style=3D'width:304.5pt;border:solid windowte=
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ight:0mm;
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mple;
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 1.0pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
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family:
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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263;&#65289;</p>
  </td>
  <td width=3D84 valign=3Dtop style=3D'width:63.0pt;border-top:none;border-=
left:none;
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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754;&#22243;</p>
  </td>
  <td width=3D406 valign=3Dtop style=3D'width:304.5pt;border-top:none;borde=
r-left:
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;line-height:17.0pt;mso-=
line-height-rule:
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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627;&#12398;&#25351;&#31034;&#12289;&#35480;&#23566;&#21450;&#12403;&#25937=
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  <p class=3DMsoPlainText style=3D'line-height:17.0pt;mso-line-height-rule:=
exactly;
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  <p class=3DMsoPlainText style=3D'margin-bottom:4.0pt;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
>&#65301;&#12288;&#24120;&#20633;&#28040;&#38450;&#12392;&#12398;&#36899;&#=
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  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;margin-right:0mm;margin-b=
ottom:
0mm;margin-left:31.5pt;margin-bottom:.0001pt;text-indent:-31.5pt;mso-char-i=
ndent-count:
-3.0;punctuation-wrap:simple'><span style=3D'mso-hansi-font-family:"MS Minc=
ho"'>&#12288;<span
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=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
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lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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style=3D'mso-hansi-font-family:"MS Mincho"'>&#12288;&#12288;&#12452;&#12288=
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e'><span
style=3D'mso-hansi-font-family:"MS Mincho"'>&#12288;&#12288;&#12454;&#12288=
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<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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e'><span
style=3D'mso-hansi-font-family:"MS Mincho"'>&#12288;&#12288;&#12288;&#12288=
;&#21508;&#37096;&#38263;&#12399;&#12289;&#28797;&#23475;&#12398;&#31278;&#=
39006;&#12395;&#24540;&#12376;&#12390;&#26412;&#37096;&#36899;&#32097;&#217=
29;&#12434;&#25351;&#21517;&#12375;&#12289;&#26412;&#37096;&#23460;&#12395;=
&#20986;&#21521;&#12373;&#12379;&#12289;&#28797;&#23475;&#24773;&#22577;&#1=
2398;&#25226;&#25569;&#12289;&#25972;&#29702;&#12289;&#21508;&#37096;&#2967=
7;&#12395;&#23550;&#12377;&#12427;&#36899;&#32097;&#12289;&#36890;&#22577;&=
#12289;&#38450;&#28797;&#38306;&#20418;&#27231;&#38306;&#12392;&#12398;&#36=
899;&#32097;&#35519;&#25972;&#31561;&#12398;&#27963;&#21205;&#12395;&#24403=
;&#12383;&#12425;&#12379;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;line-height:18.5pt;mso-line-height-rule:exactly;punctuation-wrap:simpl=
e'><span
style=3D'mso-hansi-font-family:"MS Mincho"'>&#12288;&#12288;&#12456;&#12288=
;&#38450;&#28797;&#38306;&#20418;&#27231;&#38306;&#12399;&#24517;&#35201;&#=
12395;&#24540;&#12376;&#12289;&#36899;&#32097;&#21729;&#12434;&#26412;&#370=
96;&#23460;&#12395;&#27966;&#36963;&#12377;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'line-height:18.5pt;mso-line-height-rule:ex=
actly;
punctuation-wrap:simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;=
</o:p></span></p>

<p class=3DMsoPlainText style=3D'line-height:18.5pt;mso-line-height-rule:ex=
actly;
punctuation-wrap:simple;text-autospace:none'><span style=3D'font-family:"MS=
 Gothic";
mso-hansi-font-family:"Courier New"'>&#31532;&#65298;&#12288;&#37197;&#2063=
3;&#20307;&#21046;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'line-height:18.5pt;mso-line-height-rule:ex=
actly;
punctuation-wrap:simple;text-autospace:none'><span style=3D'font-family:"MS=
 Gothic";
mso-hansi-font-family:"Courier New"'>&#65297;&#12288;&#37197;&#20633;&#2030=
7;&#21046;&#12398;&#31278;&#39006;&#12392;&#22522;&#28310;</span></p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;line-height:18.5pt;mso-line-height-rule:exactly;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#28797;&#23475;&#12398;&#30330;&#2998=
3;&#12364;&#20104;&#24819;&#12373;&#12428;&#12427;&#22580;&#21512;&#21448;&=
#12399;&#28797;&#23475;&#12364;&#30330;&#29983;&#12375;&#12383;&#22580;&#21=
512;&#12395;&#12362;&#12356;&#12390;&#12289;&#38450;&#28797;&#27963;&#21205=
;&#12434;&#25512;&#36914;&#12377;&#12427;&#12383;&#12417;&#12289;&#38450;&#=
28797;&#20307;&#21046;&#12434;&#37197;&#20633;&#12377;&#12427;&#12418;&#123=
98;&#12392;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;line-height:18.5pt;mso-line-height-rule:exactly;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#24066;&#12364;&#12392;&#12427;&#1240=
9;&#12365;&#20307;&#21046;&#12399;&#12289;&#29366;&#27841;&#12395;&#24540;&=
#12376;&#12390;&#27880;&#24847;&#20307;&#21046;&#12289;&#35686;&#25106;&#20=
307;&#21046;&#12289;&#38750;&#24120;&#20307;&#21046;&#65288;&#28797;&#23475=
;&#23550;&#31574;&#26412;&#37096;&#35373;&#32622;&#65289;&#12392;&#12377;&#=
12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;line-height:18.5pt;mso-line-height-rule:exactly;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#37197;&#20633;&#12395;&#12388;&#1235=
6;&#12390;&#12399;&#12289;&#26412;&#24193;&#12539;&#25903;&#25152;&#21336;&=
#20301;&#12391;&#34892;&#12358;&#12418;&#12398;&#12392;&#12377;&#12427;&#12=
364;&#12289;&#25903;&#25152;&#12395;&#12362;&#12356;&#12390;&#12399;&#12289=
;&#25903;&#25152;&#38263;&#12398;&#21028;&#26029;&#12395;&#12424;&#12426;&#=
12289;&#37197;&#20633;&#20307;&#21046;&#12434;&#12392;&#12427;&#12371;&#123=
92;&#12364;&#12391;&#12365;&#12289;&#12371;&#12398;&#22580;&#21512;&#12289;=
&#36895;&#12420;&#12363;&#12395;&#12381;&#12398;&#26088;&#12434;&#20225;&#3=
0011;&#36001;&#25919;&#37096;&#38263;&#12395;&#36890;&#30693;&#12375;&#1239=
4;&#12369;&#12428;&#12400;&#12394;&#12425;&#12394;&#12356;&#12290;</p>

<p class=3DMsoPlainText style=3D'line-height:18.5pt;mso-line-height-rule:ex=
actly;
punctuation-wrap:simple;text-autospace:none'>&#12288;<span lang=3DEN-US>(1)=
</span>&#12288;&#27880;&#24847;&#20307;&#21046;</p>

<p class=3DMsoPlainText style=3D'margin-bottom:5.0pt;line-height:18.5pt;mso=
-line-height-rule:
exactly;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#1245=
0;&#12288;&#37197;&#20633;&#22522;&#28310;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D560
 style=3D'width:420.0pt;margin-left:36.9pt;border-collapse:collapse;border:=
none;
 mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:
 0mm 5.4pt 0mm 5.4pt;mso-border-insideh:.5pt solid windowtext;mso-border-in=
sidev:
 .5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D28 style=3D'width:21.3pt;border:solid windowtext 1.0pt;mso-bo=
rder-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#8470;</p>
  </td>
  <td width=3D392 style=3D'width:294.2pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37197;&#12288;&#20633;&#12288;&#22522;&#12288;&#28=
310;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#26412;&#24193;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37329;&#20809;</p>
  </td>
  <td width=3D46 style=3D'width:34.5pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#23492;&#23798;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid;height:92.0pt'>
  <td width=3D28 style=3D'width:21.3pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:92.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9312;</p>
  </td>
  <td width=3D392 style=3D'width:294.2pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:9=
2.0pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:17.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12288;&#31649;&#20=
869;&#12395;&#27425;&#12398;&#12356;&#12378;&#12428;&#12363;&#12398;&#27880=
;&#24847;&#22577;&#12364;&#30330;&#34920;&#12373;&#12428;&#12289;&#28797;&#=
23475;&#12398;&#30330;&#29983;&#12364;&#20104;&#24819;&#12373;&#12428;&#124=
27;&#12392;&#12365;</p>
  <p class=3DMsoNormal style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#22823;&#38632;&#27=
880;&#24847;&#22577;</p>
  <p class=3DMsoHeader style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  tab-stops:42.55pt center 212.6pt right 425.2pt;layout-grid-mode:both;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#27946;&#27700;&#27=
880;&#24847;&#22577;</p>
  <p class=3DMsoHeader style=3D'margin-bottom:4.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;tab-stops:42.55pt center 212.6pt right 425.2pt;layout-grid-mode:b=
oth;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#39640;&#28526;&#27=
880;&#24847;&#22577;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:92.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:92.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D46 style=3D'width:34.5pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:92.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2'>
  <td width=3D28 style=3D'width:21.3pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9313;</p>
  </td>
  <td width=3D392 style=3D'width:294.2pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0mm;margin-bo=
ttom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'>&#12288;<span style=3D'lette=
r-spacing:
  -.05pt'>&#31649;&#20869;&#12398;&#27827;&#24029;&#12364;&#22679;&#27700;&=
#12375;&#12289;&#28797;&#23475;&#30330;&#29983;&#12414;&#12391;&#12363;&#12=
394;&#12426;&#12398;&#26178;&#38291;&#30340;&#20313;&#35029;&#12364;&#12354=
;&#12427;&#12364;&#12289;&#20170;&#24460;&#12398;&#29366;&#27841;&#12398;&#=
25512;&#31227;&#12395;&#27880;&#24847;&#12539;&#35686;&#25106;&#12434;&#352=
01;&#12377;&#12427;&#12392;&#12365;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D46 style=3D'width:34.5pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3'>
  <td width=3D28 style=3D'width:21.3pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9314;</p>
  </td>
  <td width=3D392 style=3D'width:294.2pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoHeader style=3D'margin-top:5.0pt;margin-right:0mm;margin-bo=
ttom:
  5.0pt;margin-left:0mm;tab-stops:42.55pt center 212.6pt right 425.2pt;
  layout-grid-mode:both;punctuation-wrap:simple;text-autospace:none'>&#1228=
8;&#21508;&#25903;&#25152;&#12424;&#12426;&#27880;&#24847;&#20307;&#21046;&=
#12434;&#12392;&#12387;&#12383;&#26088;&#12398;&#36890;&#30693;&#12364;&#12=
354;&#12387;&#12383;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:-5.65pt;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#65288;&#9675;&#65289;</p>
  </td>
  <td width=3D46 style=3D'width:34.5pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:-5.65pt;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#65288;&#9675;&#65289;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4;mso-yfti-lastrow:yes'>
  <td width=3D28 style=3D'width:21.3pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9315;</p>
  </td>
  <td width=3D392 style=3D'width:294.2pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0mm;margin-bo=
ttom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'>&#12288;&#12381;&#12398;&#20=
182;&#12289;&#22823;&#35215;&#27169;&#12394;&#28797;&#23475;&#12364;&#30330=
;&#29983;&#12377;&#12427;&#12362;&#12381;&#12428;&#12364;&#12354;&#12426;&#=
12289;&#24066;&#38263;&#12364;&#24517;&#35201;&#12392;&#35469;&#12417;&#123=
83;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D46 style=3D'width:34.5pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-bottom:5.0pt;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#12452;&#12288;&#37197;&#20633;&#2086=
9;&#23481;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D560
 style=3D'width:420.0pt;margin-left:36.9pt;border-collapse:collapse;border:=
none;
 mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:
 0mm 5.4pt 0mm 5.4pt;mso-border-insideh:.5pt solid windowtext;mso-border-in=
sidev:
 .5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D112 valign=3Dtop style=3D'width:84.0pt;border:solid windowtex=
t 1.0pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D448 style=3D'width:336.0pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37197;&#12288;&#20633;&#12288;&#20154;&#12288;&#21=
729;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid;height:55.0pt'>
  <td width=3D112 style=3D'width:84.0pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:55.0pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#24066;&#24441;&#25152;&#26412;&#24193;</p>
  </td>
  <td width=3D448 style=3D'width:336.0pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:5=
5.0pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:17.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12288;&#27880;&#24=
847;&#20307;&#21046;&#29677;&#12434;&#32232;&#25104;&#12375;&#12289;&#23550=
;&#24540;&#12377;&#12427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;</=
p>
  <p class=3DMsoNormal style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#20225;&#30011;&#36=
001;&#25919;&#37096;&#38263;&#12288;&#12288;&#12539;&#29987;&#26989;&#24314=
;&#35373;&#37096;&#38263;&#12288;&#12288;&#12539;&#32207;&#21209;&#35506;&#=
38263;</p>
  <p class=3DMsoNormal style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#24314;&#35373;&#35=
506;&#38263;&#12288;&#12288;&#12288;&#12288;&#12539;&#29987;&#26989;&#25391=
;&#33288;&#35506;&#38263;</p>
  <p class=3DMsoHeader style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  tab-stops:42.55pt center 212.6pt right 425.2pt;layout-grid-mode:both;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#32207;&#21209;&#35=
506;&#12289;&#24314;&#35373;&#35506;&#12289;&#29987;&#26989;&#25391;&#33288=
;&#35506;&#32887;&#21729;&#12398;&#12358;&#12385;&#12289;&#21508;&#35506;&#=
38263;&#12364;&#25351;&#21517;&#12377;&#12427;&#32773;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:29.55pt'>
  <td width=3D112 style=3D'width:84.0pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:29.55pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;text-align:=
center;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DZH-TW style=3D'mso-fareast-language:ZH-=
TW'>&#37329;&#20809;&#32207;&#21512;&#25903;&#25152;</span></p>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:4.0pt;text-ali=
gn:center;
  line-height:17.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;
  text-autospace:none'><span lang=3DZH-TW style=3D'mso-fareast-language:ZH-=
TW'>&#23492;&#23798;&#32207;&#21512;&#25903;&#25152;</span></p>
  </td>
  <td width=3D448 style=3D'width:336.0pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:2=
9.55pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'>&#12539;&#12354;&#12425;&#12363;&#12376;&#12417;&#23450;&#12417;&#12427;&=
#38450;&#28797;&#20307;&#21046;&#19968;&#35239;&#34920;&#12395;&#12424;&#12=
427;&#32887;&#21729;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;punctuation-wrap:simple;
text-autospace:none'>&#12288;<span lang=3DEN-US>(2)</span>&#12288;&#35686;&=
#25106;&#20307;&#21046;</p>

<p class=3DMsoPlainText style=3D'margin-bottom:5.0pt;punctuation-wrap:simpl=
e;
text-autospace:none'>&#12288;&#12288;&#12450;&#12288;&#37197;&#20633;&#2252=
2;&#28310;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D560
 style=3D'width:420.0pt;margin-left:36.9pt;border-collapse:collapse;border:=
none;
 mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:
 0mm 5.4pt 0mm 5.4pt;mso-border-insideh:.5pt solid windowtext;mso-border-in=
sidev:
 .5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;mso-bo=
rder-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#8470;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37197;&#12288;&#20633;&#12288;&#22522;&#12288;&#28=
310;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#26412;&#24193;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37329;&#20809;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#23492;&#23798;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9312;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:17.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12288;&#31649;&#20=
869;&#12395;&#27425;&#12398;&#12356;&#12378;&#12428;&#12363;&#12398;&#35686=
;&#22577;&#12364;&#30330;&#34920;&#12373;&#12428;&#12289;&#28797;&#23475;&#=
12398;&#30330;&#29983;&#12364;&#20104;&#24819;&#12373;&#12428;&#12427;&#123=
92;&#12365;</p>
  <p class=3DMsoHeader style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  tab-stops:42.55pt center 212.6pt right 425.2pt;layout-grid-mode:both;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#26292;&#39080;&#35=
686;&#22577;</p>
  <p class=3DMsoNormal style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#22823;&#38632;&#35=
686;&#22577;</p>
  <p class=3DMsoNormal style=3D'line-height:17.0pt;mso-line-height-rule:exa=
ctly;
  punctuation-wrap:simple;text-autospace:none'>&#12539;&#27946;&#27700;&#35=
686;&#22577;</p>
  <p class=3DMsoNormal style=3D'margin-bottom:4.0pt;line-height:17.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12539;&#39640;&#28=
526;&#35686;&#22577;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9313;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0mm;margin-bo=
ttom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'>&#12288;&#31649;&#20869;&#12=
395;&#12362;&#12356;&#12390;&#23616;&#22320;&#30340;&#12394;&#28797;&#23475=
;&#21448;&#12399;&#37325;&#22823;&#12394;&#20107;&#25925;&#12364;&#30330;&#=
29983;&#12375;&#12289;&#21448;&#12399;&#30330;&#29983;&#12377;&#12427;&#123=
62;&#12381;&#12428;&#12364;&#12354;&#12427;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9314;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:5.0pt;margin-right:0mm;margin-bo=
ttom:
  5.0pt;margin-left:0mm;punctuation-wrap:simple;text-autospace:none'>&#1228=
8;&#27700;&#38450;&#35686;&#22577;&#12364;&#30330;&#34920;&#12373;&#12428;&=
#12383;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9675;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9315;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:5.0pt;margin-right:0mm;margin-bo=
ttom:
  5.0pt;margin-left:0mm;punctuation-wrap:simple;text-autospace:none'>&#1228=
8;&#21508;&#25903;&#25152;&#12424;&#12426;&#35686;&#25106;&#20307;&#21046;&=
#12434;&#12392;&#12387;&#12383;&#26088;&#12398;&#36890;&#30693;&#12364;&#12=
354;&#12387;&#12383;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:-5.25pt;
  margin-bottom:5.0pt;margin-left:-5.25pt;mso-para-margin-top:5.0pt;mso-par=
a-margin-right:
  -.5gd;mso-para-margin-bottom:5.0pt;mso-para-margin-left:-.5gd;text-align:
  center;punctuation-wrap:simple;text-autospace:none'>&#65288;&#9675;&#6528=
9;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:-5.25pt;
  margin-bottom:5.0pt;margin-left:-5.25pt;mso-para-margin-top:5.0pt;mso-par=
a-margin-right:
  -.5gd;mso-para-margin-bottom:5.0pt;mso-para-margin-left:-.5gd;text-align:
  center;punctuation-wrap:simple;text-autospace:none'>&#65288;&#9675;&#6528=
9;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:5;mso-yfti-lastrow:yes'>
  <td width=3D29 style=3D'width:21.9pt;border:solid windowtext 1.0pt;border=
-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9316;</p>
  </td>
  <td width=3D391 style=3D'width:293.1pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0mm;margin-bo=
ttom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'>&#12288;&#12381;&#12398;&#20=
182;&#12289;&#22823;&#35215;&#27169;&#12394;&#28797;&#23475;&#12364;&#30330=
;&#29983;&#21448;&#12399;&#20999;&#36843;&#12375;&#12289;&#24066;&#38263;&#=
12364;&#24517;&#35201;&#12392;&#35469;&#12417;&#12383;&#12392;&#12365;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
  <td width=3D47 style=3D'width:35.0pt;border-top:none;border-left:none;bor=
der-bottom:
  solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;mso-border-top=
-alt:
  solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;mso-borde=
r-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#9675;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;margin-right:0mm;margin-b=
ottom:
5.0pt;margin-left:0mm;punctuation-wrap:simple;text-autospace:none'>&#12288;=
&#12288;&#12452;&#12288;&#37197;&#20633;&#20869;&#23481;</p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D567
 style=3D'width:150.0mm;margin-left:36.9pt;border-collapse:collapse;border:=
none;
 mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:
 0mm 5.4pt 0mm 5.4pt;mso-border-insideh:.5pt solid windowtext;mso-border-in=
sidev:
 .5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D112 valign=3Dtop style=3D'width:84.3pt;border:solid windowtex=
t 1.0pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D455 colspan=3D4 style=3D'width:340.95pt;border:solid windowte=
xt 1.0pt;
  border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:
  solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'>&#37197;&#12288;&#20633;&#12288;&#20154;&#12288;&#21=
729;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid;height:23.6pt'>
  <td width=3D112 rowspan=3D3 style=3D'width:84.3pt;border-top:none;border-=
left:solid windowtext 1.0pt;
  border-bottom:none;border-right:solid windowtext 1.0pt;mso-border-top-alt:
  solid windowtext .5pt;mso-border-top-alt:solid windowtext .5pt;mso-border=
-left-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 5.4pt 0mm 5.4pt;height:23.6pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#24066;&#24441;&#25152;&#26412;&#24193;</p>
  </td>
  <td width=3D455 colspan=3D4 style=3D'width:340.95pt;border:none;border-ri=
ght:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:23.6pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'>&#12288;&#35686;&#25106;&#20307;&#21046;&#26178;&#12395;&#12362;&#12356;&=
#12390;&#12399;&#12289;&#27425;&#12398;&#37197;&#20633;&#12434;&#12392;&#12=
427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;page-break-inside:avoid;height:32.3pt'>
  <td width=3D16 rowspan=3D2 valign=3Dtop style=3D'width:11.8pt;border:none=
;border-right:
  solid windowtext 1.0pt;mso-border-left-alt:solid windowtext .5pt;mso-bord=
er-left-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 5.4pt 0mm 5.4pt;height:32.3pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D95 style=3D'width:71.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:32.3pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'><span style=3D'mso-font-kerning:0pt'>&#32207;=
&#21512;&#35519;&#25972;&#29677;</span></p>
  </td>
  <td width=3D322 style=3D'width:241.5pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:32.3pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:16.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65288;&#29677;&#38=
263;&#65289;&#20225;&#30011;&#36001;&#25919;&#37096;&#38263;</p>
  <p class=3DMsoNormal style=3D'margin-bottom:4.0pt;line-height:16.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65288;&#35201;&#21=
729;&#65289;&#27425;&#38263;&#32887;&#20197;&#19978;&#12398;&#32887;&#21729=
;&#12289;&#27973;&#21475;&#24066;&#28040;&#38450;&#22243;&#38263;</p>
  </td>
  <td width=3D22 rowspan=3D2 valign=3Dtop style=3D'width:16.65pt;border:non=
e;
  border-right:solid windowtext 1.0pt;mso-border-left-alt:solid windowtext =
.5pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-right-alt:solid wind=
owtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:32.3pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes;page-break-inside:avoid;
  height:31.7pt'>
  <td width=3D95 style=3D'width:71.0pt;border:none;border-right:solid windo=
wtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:31.7pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'><span style=3D'mso-font-kerning:0pt'>&#32207;=
&#12288;&#25324;&#12288;&#29677;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D322 style=3D'width:241.5pt;border:none;border-right:solid win=
dowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:31.7pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:16.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#65288;&#29677;&#38=
263;&#65289;&#32207;&#21209;&#35506;&#38263;</p>
  <p class=3DMsoNormal style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso-=
char-indent-count:
  -3.0;line-height:16.0pt;mso-line-height-rule:exactly;punctuation-wrap:sim=
ple;
  text-autospace:none'>&#65288;&#35201;&#21729;&#65289;&#24314;&#35373;&#35=
506;&#38263;&#12289;&#29987;&#26989;&#25391;&#33288;&#35506;&#38263;&#21450=
;&#12403;&#35506;&#38263;&#35036;&#20304;&#32887;&#20197;&#19978;&#12398;&#=
32887;&#21729;&#12398;&#12358;&#12385;&#12289;&#24066;&#38263;&#12364;&#253=
51;&#21517;&#12377;&#12427;&#32773;</p>
  <p class=3DMsoNormal style=3D'margin-top:0mm;margin-right:0mm;margin-bott=
om:4.0pt;
  margin-left:31.5pt;text-indent:-31.5pt;mso-char-indent-count:-3.0;line-he=
ight:
  16.0pt;mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospac=
e:
  none'>&#65288;&#29677;&#21729;&#65289;&#32207;&#21209;&#35506;&#12289;&#2=
4314;&#35373;&#35506;&#12289;&#29987;&#26989;&#25391;&#33288;&#35506;&#3288=
7;&#21729;&#12398;&#12358;&#12385;&#12289;&#21508;&#35506;&#38263;&#12364;&=
#25351;&#21517;&#12377;&#12427;&#32773;</p>
  </td>
 </tr>
</table>

<p class=3DMsoNormal align=3Dleft style=3D'text-align:left'><span lang=3DEN=
-US><o:p>&nbsp;</o:p></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0 wi=
dth=3D567
 style=3D'width:150.0mm;margin-left:36.9pt;border-collapse:collapse;border:=
none;
 mso-border-alt:solid windowtext .5pt;mso-yfti-tbllook:480;mso-padding-alt:
 0mm 5.4pt 0mm 5.4pt;mso-border-insideh:.5pt solid windowtext;mso-border-in=
sidev:
 .5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;page-break-inside:avoid;
  height:21.8pt'>
  <td width=3D112 rowspan=3D2 style=3D'width:84.3pt;border:solid windowtext=
 1.0pt;
  border-top:none;mso-border-left-alt:solid windowtext .5pt;mso-border-bott=
om-alt:
  solid windowtext .5pt;mso-border-right-alt:solid windowtext .5pt;padding:
  0mm 5.4pt 0mm 5.4pt;height:21.8pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'><span lang=3DEN-US><o:p>&nbsp;</o:p></span></=
p>
  </td>
  <td width=3D16 valign=3Dtop style=3D'width:11.8pt;border:none;border-righ=
t:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:21.8pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D95 style=3D'width:71.0pt;border:solid windowtext 1.0pt;border=
-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:21.8pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:5.0pt;margin-righ=
t:0mm;
  margin-bottom:5.0pt;margin-left:0mm;text-align:center;punctuation-wrap:si=
mple;
  text-autospace:none'><span style=3D'mso-font-kerning:0pt'>&#35686;&#25106=
;&#20307;&#21046;&#29677;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D322 style=3D'width:241.5pt;border:solid windowtext 1.0pt;bord=
er-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:21.8pt'>
  <p class=3DMsoNormal style=3D'margin-top:5.0pt;margin-right:0mm;margin-bo=
ttom:
  5.0pt;margin-left:0mm;punctuation-wrap:simple;text-autospace:none'>&#1228=
8;&#12354;&#12425;&#12363;&#12376;&#12417;&#23450;&#12417;&#12427;&#38450;&=
#28797;&#20307;&#21046;&#19968;&#35239;&#34920;&#12395;&#12424;&#12427;&#32=
887;&#21729;</p>
  </td>
  <td width=3D22 valign=3Dtop style=3D'width:16.65pt;border:none;border-rig=
ht:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:21.8pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1;page-break-inside:avoid;height:5.55pt'>
  <td width=3D16 valign=3Dtop style=3D'width:11.8pt;border:none;border-bott=
om:solid windowtext 1.0pt;
  mso-border-left-alt:solid windowtext .5pt;mso-border-left-alt:solid windo=
wtext .5pt;
  mso-border-bottom-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;
  height:5.55pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
  <td width=3D439 colspan=3D3 valign=3Dtop style=3D'width:329.15pt;border-t=
op:none;
  border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid =
windowtext 1.0pt;
  mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:solid wi=
ndowtext .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:5.55pt'>
  <p class=3DMsoNormal style=3D'punctuation-wrap:simple;text-autospace:none=
'><span
  lang=3DEN-US><o:p>&nbsp;</o:p></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2;height:29.55pt'>
  <td width=3D112 style=3D'width:84.3pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:29.55pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'><span lang=3DZH-TW style=3D'mso-fareast-langu=
age:
  ZH-TW'>&#37329;&#20809;&#32207;&#21512;&#25903;&#25152;</span></p>
  </td>
  <td width=3D455 colspan=3D4 style=3D'width:340.95pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:2=
9.55pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:16.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12539;&#12354;&#12=
425;&#12363;&#12376;&#12417;&#23450;&#12417;&#12427;&#38450;&#28797;&#20307=
;&#21046;&#19968;&#35239;&#34920;&#12395;&#12424;&#12427;&#32887;&#21729;</=
p>
  <p class=3DMsoNormal style=3D'margin-bottom:4.0pt;line-height:16.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12539;&#28040;&#38=
450;&#22243;&#37329;&#20809;&#26041;&#38754;&#22243;&#38263;</p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes;height:29.55pt'>
  <td width=3D112 style=3D'width:84.3pt;border:solid windowtext 1.0pt;borde=
r-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 5.4pt 0mm 5.4pt;height:29.55pt'>
  <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center;punctuatio=
n-wrap:
  simple;text-autospace:none'>&#23492;&#23798;&#32207;&#21512;&#25903;&#251=
52;</p>
  </td>
  <td width=3D455 colspan=3D4 style=3D'width:340.95pt;border-top:none;borde=
r-left:
  none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1=
.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 5.4pt 0mm 5.4pt;height:2=
9.55pt'>
  <p class=3DMsoNormal style=3D'margin-top:3.0pt;line-height:16.0pt;mso-lin=
e-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12539;&#12354;&#12=
425;&#12363;&#12376;&#12417;&#23450;&#12417;&#12427;&#38450;&#28797;&#20307=
;&#21046;&#19968;&#35239;&#34920;&#12395;&#12424;&#12427;&#32887;&#21729;</=
p>
  <p class=3DMsoNormal style=3D'margin-bottom:4.0pt;line-height:16.0pt;mso-=
line-height-rule:
  exactly;punctuation-wrap:simple;text-autospace:none'>&#12539;&#28040;&#38=
450;&#22243;&#23492;&#23798;&#26041;&#38754;&#22243;&#38263;</p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;punctuation-wrap:simple;
text-autospace:none'><span style=3D'mso-hansi-font-family:"MS Mincho"'>&#12=
288;<span
lang=3DEN-US>(3)</span>&#12288;&#38750;&#24120;&#20307;&#21046;<span lang=
=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
-char-indent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;&#37197;&#20633;&#22522;&#28310;&#1239=
9;&#12289;&#12300;&#27973;&#21475;&#24066;&#28797;&#23475;&#23550;&#31574;&=
#26412;&#37096;&#35215;&#31243;&#12301;&#65288;&#24179;&#25104;<span
lang=3DEN-US>18</span>&#24180;&#35347;&#20196;&#31532;<span lang=3DEN-US>18=
</span>&#21495;&#65289;&#12395;&#25522;&#12370;&#12427;&#12392;&#12362;&#12=
426;&#12392;&#12377;&#12427;&#65288;</span><span
style=3D'font-family:"MS Gothic"'>&#36039;&#26009;<span lang=3DEN-US>11</sp=
an>&#65293;&#65299;</span><span
style=3D'mso-hansi-font-family:"MS Mincho"'>&#21442;&#29031;&#65289;&#12290=
;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
-char-indent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-famil=
y:
"MS Gothic";mso-hansi-font-family:"MS Mincho"'>&#65298;&#12288;&#37197;&#20=
633;&#20013;&#12398;&#27963;&#21205;&#22522;&#28310;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
-char-indent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;<span lang=3DEN-US>(1)</span>&#12288;&#27880;&#24847;&=
#20307;&#21046;&#26178;&#12395;&#12362;&#12369;&#12427;&#27963;&#21205;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-bot=
tom:
5.0pt;margin-left:21.0pt;text-indent:-21.0pt;mso-char-indent-count:-2.0;
punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-font-=
family:
"MS Mincho"'>&#12288;&#12288;&#12288;&#27880;&#24847;&#20307;&#21046;&#2617=
8;&#12395;&#12399;&#12289;&#20027;&#12392;&#12375;&#12390;&#28797;&#23475;&=
#24773;&#22577;&#12398;&#36805;&#36895;&#12363;&#12388;&#30340;&#30906;&#12=
394;&#21454;&#38598;&#12539;&#20253;&#36948;&#12434;&#34892;&#12358;&#12290=
;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:25.95pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;mso=
-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#20027;&#12288;&#12288;&#123=
94;&#12288;&#12288;&#26989;&#12288;&#12288;&#21209;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#25285;&#12288;&#12288;&#244=
03;&#12288;&#12288;&#37096;&#12288;&#12288;&#35506;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:1'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#27671;&#35937;&#20104;&#35686;&#22577;&#31561;&#12398;&#21=
463;&#20449;&#12539;&#20253;&#36948;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#32207;&#21209;&#35506;&#125=
39;&#32207;&#21209;&#25391;&#33288;&#35506;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:2'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#28797;&#23475;&#24773;&#22577;&#12398;&#21454;&#38598;&#12=
539;&#20253;&#36948;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#34987;&#23475;&#29366;&#27841;&#12398;&#25226;&#25569;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862079'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;margin-right:0mm;margin-b=
ottom:
0mm;margin-left:21.0pt;margin-bottom:.0001pt;text-indent:-21.0pt;mso-char-i=
ndent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;<span lang=3DEN-US>(2)</span>&#12288;&#35686;&#25106;&=
#20307;&#21046;&#26178;&#12395;&#12362;&#12369;&#12427;&#27963;&#21205;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-top:0mm;margin-right:0mm;margin-bot=
tom:
5.0pt;margin-left:21.0pt;text-indent:-21.0pt;mso-char-indent-count:-2.0;
punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-font-=
family:
"MS Mincho"'>&#12288;&#12288;&#12288;&#35686;&#25106;&#20307;&#21046;&#2617=
8;&#12395;&#12362;&#12356;&#12390;&#12399;&#12289;&#20027;&#12392;&#12375;&=
#12390;&#28797;&#23475;&#24773;&#22577;&#12398;&#36805;&#36895;&#12363;&#12=
388;&#30340;&#30906;&#12394;&#21454;&#38598;&#12539;&#20253;&#36948;&#12392=
;&#12381;&#12428;&#12395;&#22522;&#12389;&#12367;&#24540;&#24613;&#23550;&#=
31574;&#12398;&#36969;&#20999;&#12394;&#23455;&#26045;&#12434;&#34892;&#123=
58;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<table class=3DMsoNormalTable border=3D1 cellspacing=3D0 cellpadding=3D0
 style=3D'margin-left:25.95pt;border-collapse:collapse;border:none;mso-bord=
er-alt:
 solid windowtext .5pt;mso-padding-alt:0mm 4.95pt 0mm 4.95pt;mso-border-ins=
ideh:
 .5pt solid windowtext;mso-border-insidev:.5pt solid windowtext'>
 <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;mso=
-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
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><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#20027;&#12288;&#12288;&#123=
94;&#12288;&#12288;&#26989;&#12288;&#12288;&#21209;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
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  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
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><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#25285;&#12288;&#12288;&#244=
03;&#12288;&#12288;&#37096;&#12288;&#12288;&#35506;<span
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  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
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  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#27671;&#35937;&#20104;&#35686;&#22577;&#31561;&#12398;&#21=
463;&#20449;&#12539;&#20253;&#36948;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
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  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'mso-hansi-font-family:"MS Mincho"'>&#32207;&#21209;&#35506;&#125=
39;&#32207;&#21209;&#25391;&#33288;&#35506;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
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 windowtext 1.0pt;
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-left-alt:
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#28797;&#23475;&#24773;&#22577;&#12398;&#21454;&#38598;&#12=
539;&#20253;&#36948;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border:none;border-right:solid wi=
ndowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-right-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:3'>
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-border-alt:
  solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#34987;&#23475;&#29366;&#27841;&#12398;&#25226;&#25569;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-left:
  none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:solid windo=
wtext .5pt;
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  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
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><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:4'>
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der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#28797;&#23475;&#24195;&#22577;<span lang=3DEN-US><o:p></o:=
p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
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  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
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  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:5'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#24540;&#24613;&#23550;&#31574;<span lang=3DEN-US><o:p></o:=
p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:6'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#36991;&#38627;&#23550;&#31574;<span lang=3DEN-US><o:p></o:=
p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318862080'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:8.25pt;mso-font-kerning:0pt'>&#38306;&#20418;&=
#37096;&#35506;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
 <tr style=3D'mso-yfti-irow:7;mso-yfti-lastrow:yes'>
  <td width=3D287 style=3D'width:215.25pt;border:solid windowtext 1.0pt;bor=
der-top:
  none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid window=
text .5pt;
  padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText style=3D'margin-top:3.0pt;margin-right:0mm;margin=
-bottom:
  4.0pt;margin-left:0mm;line-height:17.0pt;mso-line-height-rule:exactly;
  punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-fon=
t-family:
  "MS Mincho"'>&#38306;&#20418;&#27231;&#38306;&#12392;&#36899;&#32097;&#35=
519;&#25972;<span
  lang=3DEN-US><o:p></o:p></span></span></p>
  </td>
  <td width=3D287 style=3D'width:215.25pt;border-top:none;border-left:none;
  border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;
  mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid window=
text .5pt;
  mso-border-alt:solid windowtext .5pt;padding:0mm 4.95pt 0mm 4.95pt'>
  <p class=3DMsoPlainText align=3Dcenter style=3D'margin-top:3.0pt;margin-r=
ight:0mm;
  margin-bottom:4.0pt;margin-left:0mm;text-align:center;line-height:17.0pt;
  mso-line-height-rule:exactly;punctuation-wrap:simple;text-autospace:none'=
><span
  style=3D'text-fit:94.5pt;mso-text-fit-id:-1318861568'><span style=3D'mso-=
hansi-font-family:
  "MS Mincho";letter-spacing:5.25pt;mso-font-kerning:0pt'>&#20225;&#30011;&=
#36001;&#25919;&#37096;</span></span><span
  lang=3DEN-US style=3D'mso-hansi-font-family:"MS Mincho"'><o:p></o:p></spa=
n></p>
  </td>
 </tr>
</table>

<p class=3DMsoPlainText style=3D'margin-top:5.0pt;margin-right:0mm;margin-b=
ottom:
0mm;margin-left:21.0pt;margin-bottom:.0001pt;text-indent:-21.0pt;mso-char-i=
ndent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;<span lang=3DEN-US>(3)</span>&#12288;&#38750;&#24120;&=
#20307;&#21046;&#26178;&#12395;&#12362;&#12369;&#12427;&#27963;&#21205;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
-char-indent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;&#12288;&#12288;&#24066;&#26412;&#37096;&#12395;&#1236=
2;&#12369;&#12427;&#27963;&#21205;&#12434;&#34892;&#12358;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:21.0pt;text-indent:-21.0pt;mso=
-char-indent-count:
-2.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'font-famil=
y:
"MS Gothic";mso-hansi-font-family:"MS Mincho"'>&#65299;&#12288;&#20307;&#21=
046;&#12398;&#35299;&#38500;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'margin-left:10.5pt;text-indent:-10.5pt;mso=
-char-indent-count:
-1.0;punctuation-wrap:simple;text-autospace:none'><span style=3D'mso-hansi-=
font-family:
"MS Mincho"'>&#12288;&#12288;&#27880;&#24847;&#20307;&#21046;&#21448;&#1239=
9;&#35686;&#25106;&#20307;&#21046;&#12398;&#21407;&#22240;&#12392;&#12394;&=
#12387;&#12383;&#27671;&#35937;&#20104;&#35686;&#22577;&#12364;&#35299;&#38=
500;&#12373;&#12428;&#12427;&#12394;&#12393;&#12289;&#28797;&#23475;&#30330=
;&#29983;&#12398;&#12362;&#12381;&#12428;&#12364;&#12394;&#12367;&#12394;&#=
12387;&#12383;&#12392;&#12365;&#12399;&#12289;&#20225;&#30011;&#36001;&#259=
19;&#37096;&#38263;&#12399;&#38306;&#20418;&#37096;&#12392;&#21332;&#35696;=
&#12398;&#12358;&#12360;&#27880;&#24847;&#20307;&#21046;&#21450;&#12403;&#3=
5686;&#25106;&#20307;&#21046;&#12434;&#35299;&#38500;&#12377;&#12427;&#1239=
2;&#12392;&#12418;&#12395;&#12289;&#38306;&#20418;&#37096;&#21450;&#12403;&=
#28040;&#38450;&#22243;&#12408;&#12381;&#12398;&#26088;&#12434;&#36899;&#32=
097;&#12377;&#12427;&#12290;&#38750;&#24120;&#20307;&#21046;&#12398;&#35299=
;&#38500;&#12395;&#12388;&#12356;&#12390;&#12399;&#12289;&#24066;&#26412;&#=
37096;&#12398;&#24259;&#27490;&#12395;&#12424;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
lang=3DEN-US><o:p>&nbsp;</o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'>&#315=
32;&#65299;&#12288;&#32887;&#21729;&#12398;&#21205;&#21729;&#21450;&#12403;=
&#21442;&#38598;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'>&#652=
97;&#12288;&#21205;&#21729;&#37197;&#20633;&#25351;&#20196;&#12398;&#20253;=
&#36948;</span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;<span
lang=3DEN-US>(1)</span>&#12288;&#21220;&#21209;&#26178;&#38291;&#20869;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12450;&#12288;&#24066;&#24441;&#25152;&#26412;&#24193;=
</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12450;<span lang=3DEN-US>)</span>&#12288;&#28797;&#2=
3475;&#24773;&#22577;&#12539;&#27671;&#35937;&#24773;&#22577;&#31561;&#1239=
9;&#12289;&#32207;&#21209;&#35506;&#12364;&#21463;&#38936;&#12377;&#12427;&=
#12290;&#32207;&#21209;&#35506;&#38263;&#12399;&#12289;&#24773;&#22577;&#12=
434;&#21463;&#38936;&#12375;&#12383;&#22580;&#21512;&#12289;&#30452;&#12385=
;&#12395;&#20225;&#30011;&#36001;&#25919;&#37096;&#38263;&#12395;&#22577;&#=
21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12452;<span lang=3DEN-US>)</span>&#12288;&#20225;&#3=
0011;&#36001;&#25919;&#37096;&#38263;&#12399;&#12289;&#37197;&#20633;&#1236=
4;&#24517;&#35201;&#12391;&#12354;&#12427;&#12392;&#35469;&#12417;&#12383;&=
#22580;&#21512;&#12395;&#12399;&#12289;&#32207;&#21209;&#35506;&#38263;&#12=
434;&#36890;&#12376;&#12390;&#38306;&#20418;&#32887;&#21729;&#12395;&#37197=
;&#20633;&#25351;&#20196;&#12434;&#20253;&#36948;&#12375;&#12289;&#12381;&#=
12398;&#26088;&#12434;&#24066;&#38263;&#12539;&#21103;&#24066;&#38263;&#123=
95;&#22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12452;&#12288;&#25903;&#25152;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12450;<span lang=3DEN-US>)</span>&#12288;&#28797;&#2=
3475;&#24773;&#22577;&#12539;&#27671;&#35937;&#24773;&#22577;&#31561;&#1239=
9;&#12289;&#32207;&#21209;&#25391;&#33288;&#35506;&#12364;&#21463;&#38936;&=
#12377;&#12427;&#12290;&#32207;&#21209;&#25391;&#33288;&#35506;&#38263;&#12=
399;&#12289;&#24773;&#22577;&#12434;&#21463;&#38936;&#12375;&#12383;&#22580=
;&#21512;&#12289;&#30452;&#12385;&#12395;&#25903;&#25152;&#38263;&#12395;&#=
22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12452;<span lang=3DEN-US>)</span>&#12288;&#25903;&#2=
5152;&#38263;&#12399;&#12289;&#32207;&#21209;&#25391;&#33288;&#35506;&#3826=
3;&#12398;&#22577;&#21578;&#12434;&#21463;&#12369;&#12289;&#37197;&#20633;&=
#12364;&#24517;&#35201;&#12391;&#12354;&#12427;&#12392;&#35469;&#12417;&#12=
383;&#22580;&#21512;&#12395;&#12399;&#12289;&#32207;&#21209;&#25391;&#33288=
;&#35506;&#38263;&#12434;&#36890;&#12376;&#12390;&#38306;&#20418;&#32887;&#=
21729;&#12395;&#37197;&#20633;&#25351;&#20196;&#12434;&#20253;&#36948;&#123=
75;&#12289;&#12381;&#12398;&#26088;&#12434;&#20225;&#30011;&#36001;&#25919;=
&#37096;&#38263;&#12395;&#22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12454;&#12288;&#37197;&#20633;&#25351;&#20196;&#12398;=
&#20253;&#36948;&#26041;&#27861;</p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;&=
#12288;&#24193;&#20869;&#25918;&#36865;&#12289;&#22238;&#32218;&#38651;&#35=
441;&#12289;&#25658;&#24111;&#38651;&#35441;&#12289;&#38450;&#28797;&#34892=
;&#25919;&#28961;&#32218;&#12289;&#32887;&#21729;&#12509;&#12540;&#12479;&#=
12523;&#12289;&#25991;&#26360;&#22238;&#35239;&#21450;&#12403;&#20351;&#368=
65;&#31561;&#12395;&#12424;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;<span
lang=3DEN-US>(2)</span>&#12288;&#21220;&#21209;&#26178;&#38291;&#22806;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12450;&#12288;&#24066;&#24441;&#25152;&#26412;&#24193;=
</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12450;<span lang=3DEN-US>)</span>&#12288;&#28797;&#2=
3475;&#24773;&#22577;&#12539;&#27671;&#35937;&#24773;&#22577;&#31561;&#1239=
9;&#12289;&#23487;&#26085;&#30452;&#32773;&#12364;&#21463;&#38936;&#12377;&=
#12427;&#12290;&#23487;&#26085;&#30452;&#32773;&#12399;&#12289;&#24773;&#22=
577;&#12434;&#21463;&#38936;&#12375;&#12383;&#22580;&#21512;&#12289;&#30452=
;&#12385;&#12395;&#20225;&#30011;&#36001;&#25919;&#37096;&#38263;&#12395;&#=
22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12452;<span lang=3DEN-US>)</span>&#12288;&#20225;&#3=
0011;&#36001;&#25919;&#37096;&#38263;&#12399;&#12289;&#37197;&#20633;&#1236=
4;&#24517;&#35201;&#12391;&#12354;&#12427;&#12392;&#35469;&#12417;&#12383;&=
#22580;&#21512;&#12395;&#12399;&#12289;&#38306;&#20418;&#32887;&#21729;&#12=
395;&#37197;&#20633;&#25351;&#20196;&#12434;&#20253;&#36948;&#12375;&#12289=
;&#12381;&#12398;&#26088;&#12434;&#24066;&#38263;&#12539;&#21103;&#24066;&#=
38263;&#12395;&#22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12452;&#12288;&#25903;&#25152;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12450;<span lang=3DEN-US>)</span>&#12288;&#28797;&#2=
3475;&#24773;&#22577;&#12539;&#27671;&#35937;&#24773;&#22577;&#31561;&#1239=
9;&#12289;&#23487;&#26085;&#30452;&#32773;&#12364;&#21463;&#38936;&#12377;&=
#12427;&#12290;&#23487;&#26085;&#30452;&#32773;&#12399;&#12289;&#24773;&#22=
577;&#12434;&#21463;&#38936;&#12375;&#12383;&#22580;&#21512;&#12289;&#30452=
;&#12385;&#12395;&#25903;&#25152;&#38263;&#12395;&#22577;&#21578;&#12377;&#=
12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:52.5pt;text-indent:-52.5pt;mso=
-char-indent-count:
-5.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12288;<=
span
lang=3DEN-US>(</span>&#12452;<span lang=3DEN-US>)</span>&#12288;&#25903;&#2=
5152;&#38263;&#12399;&#12289;&#23487;&#26085;&#30452;&#32773;&#12398;&#2257=
7;&#21578;&#12434;&#21463;&#12369;&#12289;&#37197;&#20633;&#12364;&#24517;&=
#35201;&#12391;&#12354;&#12427;&#12392;&#35469;&#12417;&#12383;&#22580;&#21=
512;&#12395;&#12399;&#12289;&#32207;&#21209;&#25391;&#33288;&#35506;&#38263=
;&#12434;&#36890;&#12376;&#12390;&#38306;&#20418;&#32887;&#21729;&#12395;&#=
37197;&#20633;&#25351;&#20196;&#12434;&#20253;&#36948;&#12375;&#12289;&#123=
81;&#12398;&#26088;&#12434;&#20225;&#30011;&#36001;&#25919;&#37096;&#38263;=
&#12395;&#22577;&#21578;&#12377;&#12427;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12454;&#12288;&#37197;&#20633;&#25351;&#20196;&#12398;=
&#20253;&#36948;&#26041;&#27861;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;&#12288;&#12288;&#12288;&#25658;&#24111;&#38651;&#35441;&#12289;=
&#22238;&#32218;&#38651;&#35441;&#12289;&#38450;&#28797;&#34892;&#25919;&#2=
8961;&#32218;&#21450;&#12403;&#20351;&#36865;&#31561;&#12395;&#12424;&#1242=
7;&#12290;</p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'><span
style=3D'font-family:"MS Gothic";mso-hansi-font-family:"Courier New"'>&#652=
98;&#12288;&#32887;&#21729;&#12398;&#21442;&#38598;&#31561;<span
lang=3DEN-US><o:p></o:p></span></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple;text-autospace:non=
e'>&#12288;<span
lang=3DEN-US>(1)</span>&#12288;&#21220;&#21209;&#26178;&#38291;&#22806;&#12=
395;&#12362;&#12369;&#12427;&#21442;&#38598;</p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple;text-autospace:none'>&#12288;&#12288;&#12450;&=
#12288;&#32887;&#21729;&#12399;&#12289;&#21220;&#21209;&#26178;&#38291;&#22=
806;&#12395;&#12362;&#12356;&#12390;&#28797;&#23475;&#12364;&#30330;&#29983=
;&#12375;&#12289;&#37197;&#20633;&#25351;&#20196;&#12434;&#21463;&#12369;&#=
12383;&#12392;&#12365;&#12399;&#12289;&#30452;&#12385;&#12395;&#12354;&#124=
25;&#12422;&#12427;&#25163;&#27573;&#12434;&#12418;&#12387;&#12390;&#21442;=
&#38598;&#12375;&#12394;&#12369;&#12428;&#12400;&#12394;&#12425;&#12394;&#1=
2356;&#12290;</p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'>&#12288;&#12288;&#12452;&#12288;&#32887;&#217=
29;&#12399;&#12289;&#38651;&#35441;&#22238;&#32218;&#12364;&#19981;&#36890;=
&#12395;&#12394;&#12427;&#31561;&#12289;&#21608;&#22258;&#12398;&#29366;&#2=
7841;&#12363;&#12425;&#22823;&#35215;&#27169;&#12394;&#28797;&#23475;&#1236=
4;&#30330;&#29983;&#12375;&#12383;&#12392;&#21028;&#26029;&#12375;&#12383;&=
#22580;&#21512;&#12395;&#12399;&#12289;&#21205;&#21729;&#37197;&#20633;&#25=
351;&#20196;&#12434;&#24453;&#12383;&#12378;&#12289;&#33258;&#12425;&#21442=
;&#38598;&#12377;&#12427;&#12418;&#12398;&#12392;&#12377;&#12427;&#12290;<s=
pan
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;<span lan=
g=3DEN-US>(2)</span>&#12288;&#21442;&#38598;&#26178;&#12398;&#30041;&#24847=
;&#20107;&#38917;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#32887;&#21729;&#12399;&#12289;&#21442;&#38598;&#12395;&#24403;&#12=
383;&#12426;&#12289;&#27425;&#12398;&#28857;&#12395;&#30041;&#24847;&#12377=
;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12450;&#12288;&#26381;&#35013;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12288;&#24540;&#24613;&#27963;&#21205;&#12364;&#12391;&#12365;&#12=
427;&#26381;&#35013;&#12392;&#12377;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12452;&#12288;&#32202;&#24613;&#25514;&#32622;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
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98;&#36884;&#19978;&#12395;&#12362;&#12356;&#12390;&#12289;&#28779;&#28797;=
&#12398;&#30330;&#29983;&#21448;&#12399;&#20154;&#36523;&#20107;&#25925;&#3=
1561;&#12395;&#36973;&#36935;&#12375;&#12383;&#12392;&#12365;&#12399;&#1228=
9;&#20303;&#27665;&#12398;&#21332;&#21147;&#12434;&#27714;&#12417;&#12289;&=
#28040;&#28779;&#12539;&#25937;&#24613;&#12539;&#25937;&#21161;&#27963;&#21=
205;&#12434;&#34892;&#12358;&#12290;&#12383;&#12384;&#12375;&#12289;&#29694=
;&#22580;&#12395;&#28040;&#38450;&#32887;&#21729;&#12364;&#12356;&#12427;&#=
22580;&#21512;&#12395;&#12399;&#12289;&#12381;&#12398;&#27963;&#21205;&#124=
34;&#24341;&#12365;&#32153;&#12366;&#12289;&#24193;&#33294;&#31561;&#12395;=
&#21442;&#38598;&#12377;&#12427;&#12290;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12454;&#12288;&#24773;&#22577;&#21454;&#38598;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
-char-indent-count:
-3.0;punctuation-wrap:simple'>&#12288;&#12288;&#12288;&#12288;&#21442;&#385=
98;&#36884;&#19978;&#12395;&#12362;&#12356;&#12390;&#12418;&#12289;&#21508;=
&#22320;&#21306;&#12398;&#27425;&#12398;&#12424;&#12358;&#12394;&#34987;&#2=
3475;&#29366;&#27841;&#31561;&#12395;&#12388;&#12356;&#12390;&#24773;&#2257=
7;&#21454;&#38598;&#12375;&#12289;&#21442;&#38598;&#26178;&#12395;&#25152;&=
#23646;&#12398;&#29677;&#38263;&#65288;&#35506;&#38263;&#31561;&#65289;&#12=
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lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12539;&#24185;&#32218;&#36947;&#36335;&#31561;&#12398;&#29366;&#27=
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lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12539;&#24314;&#29289;&#12398;&#20498;&#22730;&#12289;&#25613;&#20=
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lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12539;&#28779;&#28797;&#12398;&#30330;&#29983;&#12289;&#28040;&#28=
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lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12539;&#34987;&#28797;&#32773;&#21450;&#12403;&#25937;&#21161;&#27=
963;&#21205;&#12398;&#29366;&#27841;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12288;&#12539;&#12521;&#12452;&#12501;&#12521;&#12452;&#12531;&#12398;&#29=
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lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'punctuation-wrap:simple'>&#12288;&#12288;&=
#12456;&#12288;&#21442;&#38598;&#22577;&#21578;<span
lang=3DEN-US><o:p></o:p></span></p>

<p class=3DMsoPlainText style=3D'margin-left:31.5pt;text-indent:-31.5pt;mso=
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77;&#38263;&#65288;&#35506;&#38263;&#31561;&#65289;&#12399;&#12289;&#32887;=
&#21729;&#12398;&#21442;&#38598;&#29366;&#27841;&#21450;&#12403;&#21508;&#3=
2887;&#21729;&#12364;&#21442;&#38598;&#26178;&#12395;&#21454;&#38598;&#1237=
5;&#12383;&#34987;&#23475;&#24773;&#22577;&#31561;&#12434;&#38598;&#32004;&=
#12375;&#12289;&#20225;&#30011;&#36001;&#25919;&#37096;&#38263;&#12395;&#22=
577;&#21578;&#12377;&#12427;&#12290;</p>

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