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["退職所得に係る 市・県民税 特別徴収税額納入申告内訳書",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,"*本様式を提出した場合でも、特別徴収票の提出は必要です。"]
["令和  　年 　　月　 　日 提出\n\n（宛先）福 井 市 長",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(特別徴収義務者)\n給与支払者",null,"所在地\n\n(住　所)",null,null,null,"〒",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"法人番号又は\n個人番号※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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特別徴収義務者\n指定番号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"名　称\n\n(氏　名)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
[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,"部署名\n担当者名"]
[]
["　令和　　年　　　月分",null,null,null,null,null,null,null,null,null,null,null,null,"納入年月日",null,null,null,null,null,"令和",null,null,null,"年",null,null,"月",null,null,"日","人員",null,null,null,"人",null,null,null,null,null,null,null,"納入税額",null,null,null,null,null,"円"]
[]
["退職手当等の支払を受ける者の\n個人番号・住所・氏名",null,null,null,null,null,null,null,null,null,null,null,"退職手当等の支払金額\n勤続期間及び勤続年数",null,null,null,null,null,null,null,null,null,"他の退職手当等がある場合※２",null,null,null,null,null,null,null,null,null,null,null,null,null,"今回徴収した市・県民税額※３",null,null,null,null,null,null,null,null,null,null,null,null,"退　職　区　分",null,null,null,null,null,"退職所得申告書\n提出の有無"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"支払金額及び勤続期間等",null,null,null,null,null,null,null,null,null,"支払済税額",null,null,null,"市民税",null,null,null,"県民税",null,null,null,"合計"]
["個人番号※1",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,"円","市民税　",null,null,"円",null,null,null,"円",null,null,null,"円",null,null,null,null,"円","普通",null,null,"一般",null,null,"有・無"]
[]
[]
["退職した年の１月１日現在の住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職区分",null,null,"一般・特定役員"]
["福井市",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,null,null,null,null,"・",null,null,"・"]
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[]
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["個人番号※1",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,"円","市民税",null,null,"円",null,null,null,"円",null,null,null,"円",null,null,null,null,"円","普通",null,null,"一般",null,null,"有・無"]
[]
[]
["退職した年の１月１日現在の住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職区分",null,null,"一般・特定役員"]
["福井市",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,null,null,null,null,"・",null,null,"・"]
[null,null,null,null,null,null,null,null,null,null,null,null,"自",null,null,"年",null,null,"月",null,null,"日","自",null,null,"年",null,null,"月",null,null,"日","県民税",null,null,"円"]
[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,null,null,null,null,null,"障害",null,null,"特定役員"]
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[]
[null,null,null,null,"年",null,null,"月",null,null,"日","生","勤続年数",null,null,null,null,"年","※４",null,null,null,"勤続年数",null,null,null,null,"年","※４"]
["個人番号※1",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"円",null,null,null,null,null,null,null,null,null,"円","市民税",null,null,"円",null,null,null,"円",null,null,null,"円",null,null,null,null,"円","普通",null,null,"一般",null,null,"有・無"]
[]
[]
["退職した年の１月１日現在の住所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"退職区分",null,null,"一般・特定役員"]
["福井市",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,null,null,null,null,"・",null,null,"・"]
[null,null,null,null,null,null,null,null,null,null,null,null,"自",null,null,"年",null,null,"月",null,null,"日","自",null,null,"年",null,null,"月",null,null,"日","県民税",null,null,"円"]
[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,null,null,null,null,null,"障害",null,null,"特定役員"]
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[]
[null,null,null,null,"年",null,null,"月",null,null,"日","生","勤続年数",null,null,null,null,"年","※４",null,null,null,"勤続年数",null,null,null,null,"年","※４"]
["※１",null,"個人番号および法人番号（法人番号の指定を受けていない場合は事業主の個人番号）を記載して下さい。"]
["※２",null,"他の退職手当等の支払を２事業者以上で受けている場合は、その明細を添付してください。",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,null,null,"＊複写してご使用ください。"]
["※３",null,"100円未満の端数は、切捨てです。"]
["※４",null,"１年未満の勤続年数は、切上げです。"]