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[null,"                               ※太枠のみご記入ください",null,null,null,"                                ※太枠のみご記入ください"]
["譲ります　　　　　　 年　　月　　日",null,null,null,"譲ってください　　　　 年　　月　　日"]
["用具名",null,null,null,"希望　　　用具名"]
[]
[]
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["使用期間","　新品・購入後　　　年"]
["使用回数及び状態","　未使用・　　　　回使用　"]
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["氏名",null,null,null,"氏名"]
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["住所",null,null,null,"住所"]
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["電話　　",null,null,null,"電話　　"]
["代理人氏名及び連絡先","氏名　　　　　　　　　　　　　　TEL　　　　　　　　　　　　　　　　",null,null,"代理人氏名及び連絡先","氏名　　　　　　　　　　　　　　TEL　　　　　　　　　　　　　　　　　　"]
[null,"本人との関係　　　　　　　　　　　",null,null,null,"本人との関係　　　　　　　　　　　"]
["その他",null,null,null,"その他"]
[]
["　　　月　　　　日　　　　　　　　　様　へ",null,null,null,"　　　月　　　　日　　　　　　　　　様　より"]
["川崎市宮前区社会福祉協議会",null,null,null,"川崎市宮前区社会福祉協議会"]

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