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["       臺北市政府社會局104年       月份銀髮貴人服務津貼請領清冊               單位名稱 :                                                                                                "]
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["姓名","身分證字號   ","上課日期                                      (       月     日)","上課時間                             (學校單位請註明節課及時間)","單價","時數/節課","合計金額","簽名蓋章"]
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["製表人簽章 :                                            單位章"]

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