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["  苗栗縣         鄉〈鎮市〉低收入戶房屋修繕申請表  申請日期：   年   月   日                                                                                                              "]
["申請人",null,"出生日期","    年   月   日","身分證號碼"]
["戶籍地址","        鄉〈鎮市〉      里     鄰       街路       巷        號    樓之"]
["電   話",{"$nulls":3},"申請人蓋章"]
["申請人  資格","□本縣列冊之第1、2、3款低收入戶"]
["房屋      所有權","□自有房屋"]
[null,"□租〈借〉用房屋〈所有權人〉"]
["應備文件","□1、全戶戶籍謄本。"]
[null,"□2、低收入戶證明。"]
[null,"□3、房屋及土地所有權狀影本或房屋稅單。"]
[null,"□4、租賃契約書影本〈需租賃期限十年以上者〉。"]
[null,"□5、估價單〈應蓋店章、負責人章及營利事業登記證影本〉。"]
[null,"□6、施工前照片及房屋修繕施工平面圖。"]
[null,"□7、申請人郵局存摺影本。"]
["擬改善   設備"]
["申請金額","新  台  幣        拾       萬       仟       佰         拾       元整"]
["初審意見","□符合   新台幣         拾       萬      仟      佰       拾      元整      "]
[null,"□不符合"]
["初審核章","村 里 幹 事",null,"承  辦  人","課       長","鄉〈鎮市〉長"]
[]
["複審意見","□符合   新台幣         拾       萬       仟      佰       拾      元整      "]
[null,"□不符合"]
["複審核章","承  辦  人",null,"科       長","處       長","縣       長"]
[]
["*需先申請核准後,始可修繕,請款時另檢附施工前、中、後照片〈各二份〉及施工廠商開立之發票。"]

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