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[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市議・団体用"]
["証　票　交　付　申　請　書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,"後援団体の名称"]
[]
[null,null,null,null,null,"代表者の氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人が手書きしない場合は、記名押印してください。"]
[null,null,null,null,null,"主たる事務所の所在地"]
[]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,null,"-",null,"-",null,"）"]
[]
["　公職選挙法施行令第１１０条の５第４項の証票の交付を受けたいので、同条第５項の規定により、下記のとおり申請します。"]
[]
[]
[]
["記"]
[]
["１　推薦し、又は支持する候補者等の氏名、住所、職業及び公職の種類"]
[]
[null,"氏名"]
[]
[null,"住所"]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,null,"-",null,"-",null,"）"]
[]
[null,"職業"]
[]
[null,"公職の種類",null,null,null,null,"政令指定都市の市議会議員"]
[]
[]
["２　政治団体としての届出先",null,null,null,null,null,null,null,null,"千葉県選挙管理委員会"]
[]
[]
["３　証票交付申請枚数　　　　　　枚",null,null,null,null,null,null,null,"枚"]
[]
[]
["４　立札及び看板の類を掲示する事務所の所在地並びに事務所ごとの立札及び看板の類の枚数"]
["事　務　所　の　所　在　地",null,null,null,null,null,null,null,null,null,null,null,"立札及び看板\nの類の枚数",null,null,null,"※証票№\n（記載不要）"]
[]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["　上記の後援団体の本件証票交付申請については、公職選挙法施行令第１"]
["１０条の５第５項の同意をします。なお、私に係る後援団体のすべてを通"]
["じて既に交付された証票の総数は、",null,null,null,null,null,null,null,null,null,0,"枚です。"]
[]
[null,null,null,null,null,"令和",null,null,"年",null,"月",null,"日"]
[]
[null,null,null,null,null,null,"候補者等氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,"（注）本人が手書きしない場合は、記名押印してください。"]
["【添付書類】"]
["　①政治活動用事務所の地図"]
["　②政治団体設立届又は異動届の写し"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"※記載不要（証票受領時に記載）"]
["　私は、上記申請のとおり証票を受領しました。"]
[]
[null,"令和",null,"年",null,"月",null,"日"]
[null,null,null,null,"受領者",null,"住　所"]
[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,"市議・団体用"]
["証　票　返　還　書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,"後援団体の名称"]
[]
[null,null,null,null,null,"代表者の氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人（代表者）が手書きしない場合は、記名押印してください。"]
[null,null,null,null,null,"主たる事務所の所在地"]
[]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,null,"-",null,"-",null,"）"]
[]
["　公職選挙法第１４３条第１６項第１号の政治活動のために使用する事務所に係る立札及び看板の類に表示する証票を返還します。"]
[]
[]
[]
["記"]
[]
[]
["１　証票の返還に係る選挙の種別　　政令指定都市の市議会議員"]
[]
["２　証票返還枚数　　　　　　枚",null,null,null,null,null,null,"枚"]
[]
[]
[null,null,null,"証票の一部または全部を返還できない場合は、以下に記載願います"]
[]
["　本日、返還できなかった旧証票（",null,null,null,null,null,null,null,null,null,"枚）については、適切な処分を行うと"]
["ともに、公職選挙法等に抵触するような立札及び看板の類の掲示をしないことを"]
["誓約します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
[]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,null,null,"後援団体の名称"]
[]
[null,null,null,null,null,null,null,"代表者の氏名",null,null,null,null,null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人（代表者）が手書きしない場合は、記名押印してください。"]

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[null,null,null,null,null,null,null,null,"記載例"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市議・団体用"]
["証　票　交　付　申　請　書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和",7,"年",12,"月",25,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,"後援団体の名称",null,null,null,null,null,"千葉一郎後援会"]
[]
[null,null,null,null,null,"代表者の氏名",null,null,null,null,null,"千葉　一郎",null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人が手書きしない場合は、記名押印してください。"]
[null,null,null,null,null,"主たる事務所の所在地",null,null,null,null,null,"千葉市中央区〇〇台１－２－３"]
[]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,"043","-","245","-","××××","）"]
[]
["　公職選挙法施行令第１１０条の５第４項の証票の交付を受けたいので、同条第５項の規定により、下記のとおり申請します。"]
[]
[]
[]
["記"]
[]
["１　推薦し、又は支持する候補者等の氏名、住所、職業及び公職の種類"]
[]
[null,"氏名",null,null,null,null,"千葉　一郎"]
[]
[null,"住所",null,null,null,null,"千葉市中央区千葉港１－Ｘ　○○ビル７０１号室"]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,"090","-","245","-","△△△△","）"]
[]
[null,"職業",null,null,null,null,"市議会議員",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←市議会議員、政党役員、団体役員、\n会社員、無職等の職業を記載します。"]
[]
[null,"公職の種類",null,null,null,null,"政令指定都市の市議会議員"]
[]
[]
["２　政治団体としての届出先",null,null,null,null,null,null,null,null,"千葉県選挙管理委員会"]
[]
[]
["３　証票交付申請枚数　　　　　　枚",null,null,null,null,null,2,null,"枚"]
[]
[]
["４　立札及び看板の類を掲示する事務所の所在地並びに事務所ごとの立札及び看板の類の枚数"]
["事　務　所　の　所　在　地",null,null,null,null,null,null,null,null,null,null,null,"立札及び看板\nの類の枚数",null,null,null,"※証票№\n（記載不要）"]
[]
["千葉市中央区",null,null,null,"新宿２－△－□",null,null,null,null,null,null,null,1]
["千葉市中央区",null,null,null,"〇〇台1-2-3",null,null,null,null,null,null,null,1]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["千葉市　　区"]
["　上記の後援団体の本件証票交付申請については、公職選挙法施行令第１１０条の５第５項の同意をします。なお、私に係る後援団体のすべてを通じて既に交付された証票の総数は、0枚です。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←新証票における交付総数のため、初回申請時は0枚となります。"]
[]
[null,null,null,null,null,"令和",null,7,"年",12,"月",25,"日"]
[]
[null,null,null,null,null,null,"候補者等氏名",null,null,null,"千葉　一郎",null,null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,"（注）本人が手書きしない場合は、記名押印してください。"]
["【添付書類】"]
["　①政治活動用事務所の地図"]
["　②政治団体設立届又は異動届の写し"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"※記載不要（証票受領時に記載）"]
["　私は、上記申請のとおり証票を受領しました。"]
[]
[null,"令和",null,"年",null,"月",null,"日"]
[null,null,null,null,"受領者",null,"住　所"]
[null,null,null,null,null,null,"氏　名"]

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[null,null,null,null,null,null,null,null,"記載例"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市議・団体用"]
["証　票　返　還　書"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和",7,"年",12,"月",25,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,"後援団体の名称",null,null,null,null,null,"千葉一郎後援会"]
[]
[null,null,null,null,null,"代表者の氏名",null,null,null,null,null,"千葉　一郎",null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人（代表者）が手書きしない場合は、記名押印してください。"]
[null,null,null,null,null,"主たる事務所の所在地",null,null,null,null,null,"千葉市中央区〇〇台１－２－３"]
[null,null,null,null,null,null,null,null,null,null,null,"千葉○○ビル701"]
[null,null,null,null,null,null,null,null,null,null,"（電話",null,"043","-","245","-","5586","）"]
[]
["　公職選挙法第１４３条第１６項第１号の政治活動のために使用する事務所に係る立札及び看板の類に表示する証票を返還します。"]
[]
[]
[]
["記"]
[]
[]
["１　証票の返還に係る選挙の種別　　政令指定都市の市議会議員"]
[]
["２　証票返還枚数　　　　　　枚",null,null,null,null,5,null,"枚"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←証票返還書と同時に市に返却する証票の個数を記入してください。"]
[null,null,null,"証票の一部または全部を返還できない場合は、以下に記載願います"]
[]
["　本日、返還できなかった旧証票（",null,null,null,null,null,null,null,null,1,"枚）については、適切な処分を行うと"]
["ともに、公職選挙法等に抵触するような立札及び看板の類の掲示をしないことを"]
["誓約します。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"令和",7,"年",12,"月",25,"日"]
[]
["（あて先）千葉市選挙管理委員会委員長"]
[]
[null,null,null,null,null,null,null,"後援団体の名称",null,null,null,"千葉一郎後援会"]
[]
[null,null,null,null,null,null,null,"代表者の氏名",null,null,null,"千葉　一郎",null,null,null,null,null,null,null,null,null,"←氏名をパソコン入力の場合は押印してください。"]
[null,null,null,null,null,null,null,null,null,null,null,"（注）本人（代表者）が手書きしない場合は、記名押印してください。"]