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[null,"減免申請書（軽自動車税（環境性能割）分）"]
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[null,"　長野県知事　様",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請者",null,null,null,"〒"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住　所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"フリガナ  "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号\n(ハイフン不要)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,187]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"個人番号",null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"："]
[]
[]
[]
[null,"税　　目",null,null,null,null,"年度",null,"課税標準額又は年税率",null,null,null,null,null,null,null,null,"課税額①",null,null,null,null,null,null,"減免額②",null,null,null,null,null,null,"納付額①－②"]
[null,"環境性能割",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,"種別割",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円",null,null,null,null,null,null,"円"]
[null,"自 動 車","登録番号\n長野:1、松本:2、諏訪:4、\n安曇野:5、\n南信州:6",null,null,7,"例： 1 500 ﾀ ○○○○",null,null,null,null,null,null,null,"車名",null,null,null,null,null,null,null,"乗車定員",null,null,null,"人","最　大\n積載量",null,null,null,null,"kg","総排気量",null,null,null,"cc"]
[]
[null,null,"種　別",null,null,"普通・小型・軽",null,null,null,null,null,null,"用途",null,"乗用･貨物・( 　 　 )",null,null,null,null,null,null,"自動車の特別な仕様及び構造に関する事項"]
[null,null,"取得年月日",null,null,null,null,null,null,null,null,null,"初度登録年",null,null,null,null,null,null,null,"年"]
[null,null,"　所有者\n(所有権留保付自動車の場合は使用者)",null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"障がい者との関係"]
[null,null,null,null,null,"氏名",null,null,null,null,null,null,null,null,165,null,"納税者番号"]
[]
[null,"減免を受けようとする理由及び使用目的",null,null,null,"障がい者が通院・通学・通勤その他日常生活の必要のために使用するため",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,201,"自動車を専ら利用する者の範囲",null,null,null,null,null,null,null,"障がい者本人"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"0本人1他"]
[null,"身体障がい者等","区　分",null,null,"住　　所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　　名",null,null,null,null,null,null,null,null,null,null,null,null,"障がい者との関係"]
[null,null,"障がい者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,91,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,"0本人 1父母\n2兄弟 3子 \n4配偶 5祖父母 \n6内縁 \n7日常的介護 \n9他"]
[]
[]
[]
[null,null,null,null,null,"住所\nコード",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,104,"漢　字　（氏名の間を１字空けてください。）"]
[]
[]
[null,null,null,null,null,"番地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日"]
[]
[null,null,null,null,null,"方書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,126,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[null,null,"運 転 者",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,255,"フリガナ"]
[]
[]
[null,null,null,null,null,"住所\nコード"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,268,"漢　字　（氏名の間を１字空けてください。）",null,null,null,null,null,null,null,null,null,null,null,"障がい者との関係",null,"身体18歳未満"]
[null,null,null,null,null,"番地"]
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[null,null,null,null,null,"方書",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,290,{"$f":"IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"本人\",\"0\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"父母\",\"1\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"兄弟（姉妹）\",\"2\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"子\",\"3\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"配偶者\",\"4\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"祖父母・孫・子の妻\",\"5\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"内縁の妻\",\"6\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"日常的介護者\",\"7\",IF(\"${【７９】障がい者から見た自動車の運転者との関係（続柄）}\"=\"その他\",\"9\",\"\")))))))))","v":""},291]
[]
[]
[null,null,"運転免許証","番　号",null,null,null,null,null,null,null,null,null,null,null,null,"障がい者手帳","手帳種別",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,135]
[null,null,null,"交付日",null,"平成・令和　　年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,"障がい名",null,null,null,"合併（ 　）視覚（　 ）聴覚（ 　）平衡（ 　）上肢（ 　）"]
[null,null,null,"有効期限",null,"平成・令和　　年　　月　　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"下肢（　 ）体幹（ 　）心臓（ 　）腎臓（　 ）呼吸器（　 ）"]
[null,null,null,"種　類",null,"普通・中型・大型・（　　　 ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"膀胱・直腸（　）小腸（ 　）喉頭（ 　）免疫（ 　）"]
[null,null,null,"条　件",null,"中型車は中型車(8ｔ)に限る\n眼鏡等　・AT車限定\n(　 　　　 )",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"肝臓（ 　）知的（　　）　精神（　）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"番　号\n(左詰め)",null,null,null,136,null,null,null,null,null,null,null,null,null,null,null,"発行者\nコード",null,133]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"交 付 日",null,null,null,146,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"県税事務所整理欄","還　　付",null,null,null,null,null,null,"口座名義人",null,null,null,null,null,null,null,null,null,null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,"委任状：有・無"]
[null,null,null,null,null,null,null,null,null,"金融機関"]
[null,null,"既減免車",null,null,"無・有（登録番号：　　　　　　　　　処分状況：H・R　　　.　　　.　　　抹消・転出・移転）"]
[null,null,"申 請 車",null,null,"納税義務者：現所有者・第三者",null,null,null,null,null,null,null,null,null,null,null,"障がい内容",null,null,null,153,null,null,null,"合併内訳",null,null,156]
[null,null,"手帳再交付",null,null,"無・有（再交付日：H・R　　.　　.　　　理由：　　　　　　　　　　　　　　　　　　）"]
[null,null,"減免事由",null,null,"自動車取得・手帳交付・等級変更・申請・他（　　　　　　　　　　　　　　 ）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"確認印"]
[null,null,"日・番号",null,null,"16 申請",null,null,null,null,null,null,"23 承認",null,null,null,null,null,null,"30 減免始期",null,null,null,null,null,null,"1 身障減免番号",null,null,null,null,null,"37 年度"]
[null,null,null,null,null,5,null,null,null,null,null,null,5,null,null,null,null,null,null,5]
[null,null,null,292]
[null,null," メ　モ"]
[]
[null,"（お願い）申請書の審査及び翌年度以降の自動車税の減免の自動継続の審査のため、今回提出いただいた申請事項について、手帳発行者及び市町村役場に県税務課から確認の照会をすることがありますのでご了承ください。"]