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[]
["福井市介護サービス事業所等への物価高騰対策支援事業補助金交付申請書兼請求書  ②"]
[]
[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,null,null,null,null,null,null,"令和",null,null,7,null,null,"年",null,7,null,null,"月",null,1,null,null,"日"]
[null,null,"福井市長　様"]
[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,null,null,null,"〒",null,null,910,null,null,null,"-",null,8511]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申請者",null,null,null,null,null,"法人住所",null,null,null,null,null,"福井県福井市大手３丁目１０－１"]
[]
[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,"法人名称",null,null,null,null,null,"社会福祉法人　●●会"]
[]
[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,"代表職・氏名",null,null,null,null,null,"理事長　　▲▲　▲▲",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担当者（TEL）",null,null,null,null,null,"××　××",null,null,null,null,null,null,null,null,null,"（TEL：　20-5715　）"]
[]
[null,null,"福井市介護サービス事業所等への物価高騰対策支援事業補助金交付要綱第５条の規定により、"]
[null,null,"関係書類を添え、下記のとおり令和６年8月～１０月分(電気料[追加分]）を申請します。"]
[]
[null,"１　交付申請（請求）額",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"'【別紙】　支給対象事業所内訳書'!C4","v":262260},null,null,null,null,null,null,null,null,null,null,null,null,null,"円"]
[]
[]
[null,"２　交付申請（請求）額　内訳",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"別紙のとおり"]
[]
[null,"３　振込口座情報"]
[null,null,"補助金は、次の口座に振り込んでください。(「前回支給時の口座」か「下記の口座」かいずれかを選択)"]
[null,null,null,"　前回支給時の口座"]
[]
[null,"〇",null,"　下記の口座"]
[]
[null,"金融機関名",null,null,null,null,null,null,"●●　銀行",null,null,null,null,null,null,null,null,null,null,null,null,null,"支店名",null,null,null,"●●　支店",null,null,null,null,null,null,null,null,null,null,null,"口座種別",null,null,null,null,"１ 普通　 ２ 当座"]
[null,"金融機関コード",null,null,null,null,null,null,"１",null,"2",null,"３",null,"４",null,"支店コード",null,null,null,null,"５",null,"６",null,"７",null,"口座番号（右詰め）",null,null,null,null,null,null,null,null,null,null,"0",null,"0",null,"０",null,"１",null,"２",null,"３",null,"４"]
[null,"フリガナ",null,null,null,null,null,null,null,null,null,"ｼｬｶｲﾌｸｼﾎｳｼﾞﾝ●●ｶｲ　ﾘｼﾞﾁｮｳ　▲▲　▲▲"]
[null,"口座名義人",null,null,null,null,null,null,null,null,null,"社会福祉法人　●●会　理事長　　▲▲　▲▲"]
[]
[null,null,"※預金種別については、該当するものに○をつけてください。"]
[null,null,"※口座名義人（フリガナ）は通帳の記載どおりに記入してください。"]
[]
[]
[null,"４　誓約事項"]
[null,null,"以下の全ての事項について誓約します。"]
[null,"①",null,"支給対象要件を満たしていること。"]
[null,"②",null,"申請者及び役員等が、福井市暴力団排除条例第２条第１号に規定する暴力団若しくは同条第３号に規定する暴力団員等又は暴力団若しくは同条第２号に規定する暴力団員と社会的に非難されるべき関係を有する者でないこと、かつ将来にわたっても該当しないこと。"]
[]
[]
[null,"③",null,"以下の必要書類を全て提出するとともに、当該書類に虚偽がないこと。"]
[null,null,null,"・補助金交付申請書兼請求書（本様式第１号）"]
[null,null,null,"・補助金支給対象事業所内訳書（別紙）"]
[null,null,null,"・振込口座　通帳の写し"]
[null,null,null,"・サービス種別毎の定員が分かる書類（運営規定等）の写し"]
[null,"④",null,"申請に係る虚偽が判明した場合は、要綱の規定に基づき、補助金の返還に応じること。"]
[null,"⑤",null,"個人情報の取扱いに関して、支給手続きに必要な範囲で、市が共有することに同意すること。"]
[null,"⑥",null,"前各号のほか、要綱の規定を遵守すること。"]
[]
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["（別紙）　　　　　　　　　　　　福井市介護サービス事業所等への物価高騰対策支援事業補助金　 支給対象事業所内訳書（R6.8～10月電気料）",null,null,null,null,null,null,null,"③"]
[]
["法人名",null,"社会福祉法人　●●会"]
["補助金　申請（請求）額",null,{"$f":"SUM(I8:I32)","v":262260}]
[]
[]
["No.","事業所名","事業所番号","区分","サービス種別","算定\n月数","基準額","定員数","交付額"]
[1,"特別養護老人ホーム●●","1870XXXXXX",{"$f":"IFERROR((VLOOKUP(E8,K:L,2,0))&\"\",\"\")","v":"入所系"},"介護老人福祉施設",3,{"$f":"IFERROR(VLOOKUP(D8,N:O,2,0),\"\")","v":1800},100,{"$f":"IF(D8=\"訪問系\",IF(OR(F8=1,F8=2),ROUNDDOWN(G8*F8/3,-3),G8),IF(OR(D8=\"通所系\",D8=\"入所系\"),IF(OR(F8=1,F8=2),ROUNDDOWN(G8*H8*F8/3,-3),G8*H8),\"\"))","v":180000},null,"訪問介護","訪問系",null,"入所系",1800]
[2,"デイサービス●●","1870XXXXXX","通所系","通所介護",3,2380,18,{"$f":"IF(D9=\"訪問系\",IF(OR(F9=1,F9=2),ROUNDDOWN(G9*F9/3,-3),G9),IF(OR(D9=\"通所系\",D9=\"入所系\"),IF(OR(F9=1,F9=2),ROUNDDOWN(G9*H9*F9/3,-3),G9*H9),\"\"))","v":42840},null,"訪問入浴介護","訪問系",null,"通所系",2380]
[3,"ヘルパーステーション●●","1870XXXXXX","訪問系","訪問介護",3,19710,null,19710,null,"訪問看護","訪問系",null,"訪問系",19710]
[4,"●●介護相談センター","1870XXXXXX","訪問系","居宅介護支援",3,19710,null,19710,null,"訪問リハビリテーション","訪問系"]
[5,null,null,"",null,null,"",null,"",null,"定期巡回・随時対応型訪問介護看護","訪問系"]
[6,null,null,"",null,null,"",null,"",null,"福祉用具貸与","訪問系"]
[7,null,null,{"$f":"IFERROR((VLOOKUP(E14,K:L,2,0))&\"\",\"\")","v":""},null,null,"",null,"",null,"居宅介護支援","訪問系"]
[8,null,null,"",null,null,"",null,"",null,"地域包括支援センター","訪問系"]
[9,null,null,"",null,null,"",null,"",null,"通所介護","通所系"]
[10,null,null,"",null,null,"",null,"",null,"通所リハビリテーション","通所系"]
[11,null,null,"",null,null,"",null,"",null,"地域密着型通所介護","通所系"]
[12,null,null,"",null,null,"",null,"",null,"認知症対応型通所介護","通所系"]
[13,null,null,"",null,null,"",null,"",null,"通所型サービス（第一号通所事業）","通所系"]
[14,null,null,"",null,null,"",null,"",null,"介護老人福祉施設","入所系"]
[15,null,null,"",null,null,"",null,"",null,"地域密着型介護老人福祉施設入所者生活介護","入所系"]
[16,null,null,"",null,null,"",null,"",null,"介護老人保健施設","入所系"]
[17,null,null,"",null,null,"",null,"",null,"介護医療院","入所系"]
[18,null,null,"",null,null,"",null,"",null,"ケアハウス","入所系"]
[19,null,null,"",null,null,"",null,"",null,"養護老人ホーム","入所系"]
[20,null,null,"",null,null,"",null,"",null,"認知症対応型共同生活介護","入所系"]
[21,null,null,"",null,null,"",null,"",null,"短期入所生活介護","入所系"]
[22,null,null,"",null,null,"",null,"",null,"短期入所療養介護","通所系"]
[23,null,null,"",null,null,"",null,"",null,"小規模多機能型居宅介護","通所系"]
[24,null,null,"",null,null,"",null,"",null,"複合型サービス（看護小規模多機能型居宅介護）","通所系"]
[25,null,null,"",null,null,"",null,"",null,"有料老人ホーム","訪問系"]
[null,null,null,{"$f":"IFERROR((_xlfn.XLOOKUP(E33,K:K,L:L))&\"\",\"\")","v":""},null,null,null,null,null,null,"サービス付き高齢者住宅","入所系"]
[null,null,null,{"$f":"IFERROR((_xlfn.XLOOKUP(E34,K:K,L:L))&\"\",\"\")","v":""},null,null,"整理番号"]

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["振込口座の通帳の写し　貼付台紙",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,null,null,null,null,null,null,null,null,"④"]
[]
["法人名"]
[]
["※適宜コピーして使用してください。"]
["\n通帳写し　等　貼り付け台紙\n\n枠からはみ出しても構いませんが、用紙からはみ出さないでください。\n\n\n口座名義（カナ）、口座番号等が見えるように　重ねずに　貼り付けてください。"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"整理番号　　"]

{"sheet":"リスト","index":3,"n_rows":58,"n_cols":8,"rows_kept":58,"cut":false,"hidden":true,"merged":[]}
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["介護老人福祉施設","入所系","人",30,null,"大牟田市","入所系",{"$f":"SUMIF(#REF!,G2,#REF!)","v":{"$error":"#REF!"}}]
["介護老人保健施設","入所系","人",30,null,"直方市","通所系",{"$f":"SUMIF(#REF!,G3,#REF!)","v":{"$error":"#REF!"}}]
["介護医療院","入所系","人",30,null,"飯塚市","訪問系",{"$f":"SUMIF(#REF!,G4,#REF!)","v":{"$error":"#REF!"}}]
["介護療養型医療施設","入所系","人",30,null,"田川市"]
["有料老人ホーム","入所系","人",30,null,"柳川市"]
["サービス付き高齢者向け住宅","入所系","人",30,null,"八女市"]
["軽費老人ホーム","入所系","人",30,null,"筑後市"]
["養護老人ホーム","入所系","人",30,null,"大川市"]
["短期入所療養介護（空床利用型を除く）","入所系","人",30,null,"行橋市"]
["短期入所生活介護（空床利用型を除く）","入所系","人",30,null,"豊前市"]
[null,null,null,null,null,"中間市"]
["通所介護","通所系","人",6,null,"小郡市"]
["通所リハビリテーション","通所系","人",6,null,"筑紫野市"]
[null,null,null,null,null,"春日市"]
["訪問介護","訪問系","か所",50,null,"大野城市"]
["訪問入浴介護","訪問系","か所",50,null,"宗像市"]
["訪問看護","訪問系","か所",50,null,"太宰府市"]
[null,null,null,null,null,"古賀市"]
[null,null,null,null,null,"福津市"]
[null,null,null,null,null,"うきは市"]
[null,null,null,null,null,"宮若市"]
[null,null,null,null,null,"嘉麻市"]
[null,null,null,null,null,"朝倉市"]
[null,null,null,null,null,"みやま市"]
[null,null,null,null,null,"糸島市"]
[null,null,null,null,null,"那珂川市"]
[null,null,null,null,"糟屋郡","宇美町"]
[null,null,null,null,"糟屋郡","篠栗町"]
[null,null,null,null,"糟屋郡","志免町"]
[null,null,null,null,"糟屋郡","須恵町"]
[null,null,null,null,"糟屋郡","新宮町"]
[null,null,null,null,"糟屋郡","久山町"]
[null,null,null,null,"糟屋郡","粕屋町"]
[null,null,null,null,"遠賀郡","芦屋町"]
[null,null,null,null,"遠賀郡","水巻町"]
[null,null,null,null,"遠賀郡","岡垣町"]
[null,null,null,null,"遠賀郡","遠賀町"]
[null,null,null,null,"鞍手郡","小竹町"]
[null,null,null,null,"鞍手郡","鞍手町"]
[null,null,null,null,"嘉穂郡","桂川町"]
[null,null,null,null,"朝倉郡","筑前町"]
[null,null,null,null,"朝倉郡","東峰村"]
[null,null,null,null,"三井郡","大刀洗町"]
[null,null,null,null,"三潴郡","大木町"]
[null,null,null,null,"八女郡","広川町"]
[null,null,null,null,"田川郡","香春町"]
[null,null,null,null,"田川郡","添田町"]
[null,null,null,null,"田川郡","糸田町"]
[null,null,null,null,"田川郡","川崎町"]
[null,null,null,null,"田川郡","大任町"]
[null,null,null,null,"田川郡","赤村"]
[null,null,null,null,"田川郡","福智町"]
[null,null,null,null,"京都郡","苅田町"]
[null,null,null,null,"京都郡","みやこ町"]
[null,null,null,null,"築上郡","吉富町"]
[null,null,null,null,"築上郡","上毛町"]
[null,null,null,null,"築上郡","築上町"]