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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市議・個人用"]
["証　票　再　交　付　申　請　書"]
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[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"]
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[null,null,null,null,null,"候補者等",null,null,"氏　名",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。"]
[null,null,null,null,null,null,null,null,"住　所"]
[]
["　千葉市選挙管理委員会選挙執行規程第１４３条第１項の規定により、下記のとおり再交付を申請します。"]
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["記"]
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["※証票№\n（記載不要）",null,"再交付する場所",null,null,null,null,null,null,"理由",null,null,"届出警察署名\n（予定を含む。）",null,null,null,"届出年月日\n（予定を含む。）"]
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[null,null,"千葉市　　区",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←紛失、盗難等再交付する理由を記載してください。"]
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["備考",1,"　盗難・紛失の場合は、理由にその旨を記載し、届出をした警察署名及び当該届出をした年月日(届出をしていない場合は、届出をする予定の警察署名及び年月日)を記載しなければならない。"]
[]
[null,2,"　その他の場合は、交付済の証票を返還しなければならない。"]
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["【添付書類】"]
["　①政治活動用事務所の地図"]
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[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・個人用"]
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[]
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["誓　約　書"]
[]
[]
["　私は、紛失した証票（",null,null,null,null,null,null,null,"枚）を、後日発見した場合には、直ちに返却し、"]
["公職選挙法違反となるような掲示方法に使用することはありません。"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
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["（あて先）千葉市選挙管理委員会委員長"]
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[null,null,null,null,null,null,null,"候補者等氏名"]
[null,null,null,null,null,null,null,null,null,null,"（注）本人（候補者等）が手書きしない場合は、記名押印してください。"]
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["※「誓約書」は、証票を紛失された方のみ、「証票再交付申請書」と併せて提出してください。"]

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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"市議・個人用"]
["証　票　再　交　付　申　請　書"]
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[null,null,null,null,null,null,null,null,null,null,null,null,"令和",8,"年",8,"月",25,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
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[]
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[null,null,null,null,null,"候補者等",null,null,"氏　名",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。"]
[null,null,null,null,null,null,null,null,"住　所",null,"千葉市中央区千葉港１－Ｘ　○○ビル701号室"]
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["　千葉市選挙管理委員会選挙執行規程第１４３条第１項の規定により、下記のとおり再交付を申請します。"]
[]
[]
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["記"]
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["※証票№\n（記載不要）",null,"再交付する場所",null,null,null,null,null,null,"理由",null,null,"届出警察署名\n（予定を含む。）",null,null,null,"届出年月日\n（予定を含む。）"]
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[null,null,"千葉市中央区新宿２－△－□",null,null,null,null,null,null,"紛失",null,null,"千葉中央警察署",null,null,null,"2026-08-20",null,null,null,null,"←紛失、盗難等再交付する理由を記載してください。"]
[]
[]
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["備考",1,"　盗難・紛失の場合は、理由にその旨を記載し、届出をした警察署名及び当該届出をした年月日(届出をしていない場合は、届出をする予定の警察署名及び年月日)を記載しなければならない。"]
[]
[null,2,"　その他の場合は、交付済の証票を返還しなければならない。"]
[]
["【添付書類】"]
["　①政治活動用事務所の地図"]
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[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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["証　票　再　交　付　申　請　書"]
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[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"]
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[null,null,null,null,null,"後援団体の名称"]
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[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"]
[]
["　千葉市選挙管理委員会選挙執行規程第１４３条第１項の規定により、下記のとおり再交付を申請します。"]
[]
[]
[]
["記"]
[]
["※証票№\n（記載不要）",null,"再交付する場所",null,null,null,null,null,null,"理由",null,null,"届出警察署名\n（予定を含む。）",null,null,null,"届出年月日\n（予定を含む。）"]
[]
[null,null,"千葉市　　区",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"←紛失、盗難等再交付する理由を記載してください。"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["備考",1,"　盗難・紛失の場合は、理由にその旨を記載し、届出をした警察署名及び当該届出をした年月日(届出をしていない場合は、届出をする予定の警察署名及び年月日)を記載しなければならない。"]
[]
[null,2,"　その他の場合は、交付済の証票を返還しなければならない。"]
[]
["【添付書類】"]
["　①政治活動用事務所の地図"]
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[]
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[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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["誓　約　書"]
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["　私は、紛失した証票（",null,null,null,null,null,null,null,"枚）を、後日発見した場合には、直ちに返却し、"]
["公職選挙法違反となるような掲示方法に使用することはありません。"]
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[null,null,null,null,null,null,null,null,null,null,null,null,"令和",null,"年",null,"月",null,"日"]
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["（あて先）千葉市選挙管理委員会委員長",null,null,null,null,null,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。"]
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[null,null,null,null,null,"候補者等氏名"]
[null,null,null,null,null,null,null,null,"（注）本人（候補者等）が手書きしない場合は、記名押印してください。"]
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[]
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[null,null,null,null,null,"後援団体の代表者氏名"]
[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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["※「誓約書」は、証票を紛失された方のみ、「証票再交付申請書」と併せて提出してください。"]

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["証　票　再　交　付　申　請　書"]
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[null,null,null,null,null,null,null,null,null,null,null,null,"令和",8,"年",8,"月",25,"日"]
["（あて先）千葉市選挙管理委員会委員長"]
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[null,null,null,null,null,"後援団体の名称",null,null,null,null,null,"千葉一郎後援会"]
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[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"]
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["　千葉市選挙管理委員会選挙執行規程第１４３条第１項の規定により、下記のとおり再交付を申請します。"]
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["記"]
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["※証票№\n（記載不要）",null,"再交付する場所",null,null,null,null,null,null,"理由",null,null,"届出警察署名\n（予定を含む。）",null,null,null,"届出年月日\n（予定を含む。）"]
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[null,null,"千葉市中央区〇〇台1-2-3",null,null,null,null,null,null,"盗難",null,null,"千葉中央警察署",null,null,null,"2026-08-20",null,null,null,null,"←紛失、盗難等再交付する理由を記載してください。"]
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[]
[]
["備考",1,"　盗難・紛失の場合は、理由にその旨を記載し、届出をした警察署名及び当該届出をした年月日(届出をしていない場合は、届出をする予定の警察署名及び年月日)を記載しなければならない。"]
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[null,2,"　その他の場合は、交付済の証票を返還しなければならない。"]
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["【添付書類】"]
["　①政治活動用事務所の地図"]
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[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"]