{"text_format":"1","workbook":"xlsx","n_sheets":5,"sheets":["使い方・注意事項","入力用リスト","【印刷用】証明書・領収証兼請求書（預かり保育事業）","【白紙】証明書・領収証兼請求書（預かり保育事業）","【記載例】証明書・領収証兼請求書（預かり保育事業）"],"not_rendered":{"charts":0,"images":7,"macros":1,"external_links":0,"defined_names":5,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"使い方・注意事項","index":0,"n_rows":0,"n_cols":0,"rows_kept":0,"cut":false,"hidden":false,"merged":[]}

{"sheet":"入力用リスト","index":1,"n_rows":304,"n_cols":18,"rows_kept":304,"cut":false,"hidden":false,"merged":[[1,5,1,9],[1,1,1,4],[1,0,2,0],[1,10,1,17]]}
[1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18]
["No.","認定子ども　　※全項目の入力が必要です。",null,null,null,"認定保護者　　※全項目の入力が必要です。",null,null,null,null,"預かり保育の提供状況　　※全項目の入力が必要です。（「自由記載欄（任意）」を除く）"]
[null,"氏名","氏名フリガナ","生年月日","認定番号（新2号、新3号）","氏名","氏名フリガナ","生年月日","児童との続柄","現住所","対象年","対象月","提供期間（開始日）","提供期間（終了日）","提供日数","利用料（無償化対象）","特定費用（無償化対象外）","自由記載欄（任意）"]
[0,"札幌　花","サッポロ　ハナ","2014-01-12",1234567899,"札幌　一郎","サッポロ　イチロウ","1984-05-06","父","札幌市中央区南1条東1丁目3-122",1,10,1,31,20,12000,1500,"記入例のため編集不可（印刷はされません）"]
[1,"札幌　花","サッポロ　ハナ","2019-05-01",1234567890,"札幌　一郎","サッポロ　イチロウ","1984-05-06","父","札幌市中央区南1条東1丁目3-122　",1,10,1,31,20,20000,1500]
[2,"札幌　海","サッポロ　ウミ","2013-10-01",1234567889,"札幌　一郎","サッポロ　イチロウ","1984-05-06","父","札幌市中央区南1条東1丁目3-122",1,10,1,31,18,18000,1500]
[3,"石狩　五郎","イシカリ　ゴロウ","2014-03-01",101,"石狩　太朗","イシカリ　タロウ","1983-06-18","父","札幌市西区中町10条10丁目1-11",1,10,1,31,26,70000,1200]
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{"sheet":"【印刷用】証明書・領収証兼請求書（預かり保育事業）","index":2,"n_rows":52,"n_cols":45,"rows_kept":52,"cut":false,"hidden":false,"merged":[[48,37,48,38],[49,15,49,39],[51,1,51,40],[43,35,45,35],[43,36,45,37],[43,38,45,38],[48,1,48,6],[48,7,48,8],[48,9,48,10],[48,11,48,12],[48,13,48,14],[48,15,48,20],[48,21,48,36],[42,17,42,24],[42,25,42,38],[43,1,45,4],[43,5,45,16],[43,17,45,24],[43,25,45,31],[43,32,45,32],[43,33,45,34],[42,1,42,4],[42,5,42,16],[37,1,39,4],[36,1,36,4],[36,5,36,16],[36,17,36,20],[21,25,21,37],[27,8,27,35],[36,33,36,34],[36,36,36,37],[37,5,39,14],[37,15,39,16],[37,17,38,20],[39,17,39,20],[36,21,36,31],[37,21,38,38],[39,21,39,38],[34,26,34,28],[34,33,34,34],[34,36,34,37],[17,2,21,15],[17,29,17,31],[17,33,17,34],[17,36,17,37],[18,17,18,24],[18,25,18,37],[19,17,19,24],[19,25,19,37],[20,17,20,24],[21,17,21,24],[20,25,20,37],[9,22,10,26],[6,1,6,38],[8,1,8,6],[8,7,8,13],[9,1,10,2],[9,3,10,3],[9,4,10,5],[9,6,10,6],[9,7,9,8],[9,11,9,12],[9,28,10,28],[9,29,10,33],[9,34,10,34],[9,35,10,38],[9,27,10,27],[9,14,10,14],[10,7,10,9],[10,10,10,11],[10,12,10,13],[7,1,7,13],[7,14,8,21],[9,16,10,20],[9,21,10,21],[9,15,10,15],[7,22,8,27],[7,28,8,34],[7,35,8,38],[0,4,0,35],[2,1,2,38],[3,1,5,3],[3,4,3,6],[3,20,5,22],[3,23,3,25],[3,26,3,38],[4,4,5,6],[4,23,5,25],[4,26,5,38],[3,7,3,17],[4,7,5,17]]}
[null,null,null,null," 提供証明書兼領収証（預かり保育事業）"]
[null,null,null,null,"※上部の「提供証明書兼領収証」は、保護者ではなく、必ず施設が作成してください。"]
[null,"　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　特定子ども・子育て支援提供証明書兼領収証　　　　"]
[null,"保護者\n\n(認定保護者)",null,null,"フリガナ",null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,7,FALSE)&\"\"","v":"サッポロ　イチロウ"},null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,"フリガナ",null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,3,FALSE)&\"\"","v":"サッポロ　ハナ"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"表示・印刷したい番号",1]
[null,null,null,null,"氏　名",null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,6,FALSE)&\"\"","v":"札幌　一郎"},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,2,FALSE)&\"\"","v":"札幌　花"}]
[]
[null,"提供内容並びに領収額及びその費用の内訳"]
[null,"預かり保育事業の提供状況",null,null,null,null,null,null,null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"限度額※3\n(ア)×450円",null,null,null,null,null,null,"施設自由\n記載欄"]
[null,"年月",null,null,null,null,null,"提供期間及び\n　提供日数（ア）"]
[null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,11,FALSE)&\"\"","v":"1"},null,"年",{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,12,FALSE)&\"\"","v":"10"},null,"月",{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,13,FALSE)&\"\"","v":"1"},null,"日","～",{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,14,FALSE)&\"\"","v":"31"},null,"日","(a)",null,{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,16,FALSE)=0,\"\",VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,16,FALSE))","v":20000},null,null,null,null,"円",{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,17,FALSE)","v":1500},null,null,null,null,"円","(b)",{"$f":"IFERROR(K11*450,\"\")","v":9000},null,null,null,null,"円"]
[null,null,null,null,null,null,null,"（うち",null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,15,FALSE)&\"\"","v":"20"},null,"日）"]
[null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[]
[null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額"]
[null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[null,"※3　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から預かり保育事業の利用料として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名"]
[]
[]
[null,null,"※上部の「提供証明書兼領収証」について、保護者が施設に無断で作成し又は改変を行ったときは、"]
[null,null,"　刑法上の罪に問われる場合があります。"]
[]
[null,"※以下、請求者（認定保護者）記入欄\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（預かり保育事業）　　"]
[]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
[null,"1. 請求する保護者（認定保護者）"]
[null,"フリガナ",null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,7,FALSE)&\"\"","v":"サッポロ　イチロウ"},null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",TEXT(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE),\"ggge\")&\"(\"&YEAR(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE))&\")\")","v":"昭和59(1984)"},null,null,null,null,null,null,null,null,null,null,"年",{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",MONTH(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE)))","v":5},null,"月",{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE)=0,\"\",DAY(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,8,FALSE)))","v":6},null,"日"]
[null,"氏　　　名",null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,6,FALSE)&\"\"","v":"札幌　一郎"},null,null,null,null,null,null,null,null,null,"印",null,"現住所",null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,10,FALSE)&\"\"","v":"札幌市中央区南1条東1丁目3-122　"}]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号"]
[]
[null,"2. 利用した児童（認定子ども）　※児童ごとに請求書を分けてください。"]
[null,"フリガナ",null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,3,FALSE)&\"\"","v":"サッポロ　ハナ"},null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,5,FALSE)=0,\"\",VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,5,FALSE))","v":1234567890}]
[null,"氏　　　名",null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,2,FALSE)&\"\"","v":"札幌　花"},null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",TEXT(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE),\"ggge\")&\"(\"&YEAR(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE))&\")\")","v":"令和1(2019)"},null,null,null,null,null,null,"年",{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",MONTH(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE)))","v":5},null,"月",{"$f":"IF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE)=0,\"\",DAY(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE)))","v":1},null,"日"]
[]
[]
[]
[null,"3. 在籍園の預かり保育事業の利用における施設等利用費の償還払い請求額"]
[null,"請求対象年月",null,null,null,null,null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,11,FALSE)&\"\"","v":"1"},null,"年",null,{"$f":"VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,12,FALSE)&\"\"","v":"10"},null,"月",null,"請求額※",null,null,null,null,null,{"$f":"IF(Q10=\"\",\"\",IFERROR(IF(MIN(Q10,AD10,IF(IFERROR(DATEDIF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE),DATE(YEAR(EDATE(DATE(B10+2018,E10,1),-3)),4,1),\"Y\"),0)>2,11300,16300))=0,\"\",MIN(Q10,AD10,IF(IFERROR(DATEDIF(VLOOKUP($AS$4,入力用リスト!$A$4:$R$304,4,FALSE),DATE(YEAR(EDATE(DATE(B10+2018,E10,1),-3)),4,1),\"Y\"),0)>2,11300,16300))),\"\"))","v":9000},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,null,null,null,null,null,null,"※上記「提供内容並びに領収額及びその費用の内訳」における、\n　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]

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[null,null,null,null," 提供証明書兼領収証（預かり保育事業）"]
[null,null,null,null,"※上部の「提供証明書兼領収証」は、保護者ではなく、必ず施設が作成してください。"]
[null,"　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　特定子ども・子育て支援提供証明書兼領収証　　　　"]
[null,"保護者\n\n(認定保護者)",null,null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,"フリガナ"]
[null,null,null,null,"氏　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名"]
[]
[null,"提供内容並びに領収額及びその費用の内訳"]
[null,"預かり保育事業の提供状況",null,null,null,null,null,null,null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"限度額※3\n(ア)×450円",null,null,null,null,null,null,"施設自由\n記載欄"]
[null,"年月",null,null,null,null,null,"提供期間及び\n　提供日数（ア）"]
[null,null,null,"年",null,null,"月",null,null,"日","～",null,null,"日","(a)",null,null,null,null,null,null,"円",null,null,null,null,null,"円","(b)",null,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"（うち",null,null,null,null,"日）"]
[null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[]
[null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額"]
[null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[null,"※3　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から預かり保育事業の利用料として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名"]
[]
[]
[null,null,"※上部の「提供証明書兼領収証」について、保護者が施設に無断で作成し又は改変を行ったときは、"]
[null,null,"　刑法上の罪に問われる場合があります。"]
[]
[null,"※以下、請求者（認定保護者）記入欄\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（預かり保育事業）　　"]
[]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,null,"年",null,null,"月",null,null,"日"]
[null,"1. 請求する保護者（認定保護者）"]
[null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[null,"氏　　　名",null,null,null,null,null,null,null,null,null,null,null,null,null,"印",null,"現住所"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号"]
[]
[null,"2. 利用した児童（認定子ども）　※児童ごとに請求書を分けてください。"]
[null,"フリガナ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)"]
[null,"氏　　　名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
[]
[]
[]
[null,"3. 在籍園の預かり保育事業の利用における施設等利用費の償還払い請求額"]
[null,"請求対象年月",null,null,null,null,null,null,null,"年",null,null,null,"月",null,"請求額※",null,null,null,null,null,{"$f":"IF(Q10=\"\",\"\",IFERROR(IF(MIN(Q10,AD10,IF(IFERROR(DATEDIF(VLOOKUP(#REF!,入力用リスト!$A$4:$R$304,4,FALSE),DATE(YEAR(EDATE(DATE(B10+2018,E10,1),-3)),4,1),\"Y\"),0)>2,11300,16300))=0,\"\",MIN(Q10,AD10,IF(IFERROR(DATEDIF(VLOOKUP(#REF!,入力用リスト!$A$4:$R$304,4,FALSE),DATE(YEAR(EDATE(DATE(B10+2018,E10,1),-3)),4,1),\"Y\"),0)>2,11300,16300))),\"\"))","v":""},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,null,null,null,null,null,null,"※上記「提供内容並びに領収額及びその費用の内訳」における、\n　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]

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[]
[]
[]
[null,null,null,null," 提供証明書兼領収証（預かり保育事業）"]
[null,null,null,null,"※上部の「提供証明書兼領収証」は、保護者ではなく、必ず施設が作成してください。"]
[null,"　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　　特定子ども・子育て支援提供証明書兼領収証　　　　"]
[null,"保護者\n\n(認定保護者)",null,null,"フリガナ",null,null,"サッポロ　イチロウ",null,null,null,null,null,null,null,null,null,null,null,null,"利用した\n児童\n(認定子ども)",null,null,"フリガナ",null,null,"サッポロ　ハナ"]
[null,null,null,null,"氏　名",null,null,"札幌　一郎",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏　名",null,null,"札幌　花"]
[]
[null,"提供内容並びに領収額及びその費用の内訳"]
[null,"預かり保育事業の提供状況",null,null,null,null,null,null,null,null,null,null,null,null,"利用料\n無償化対象※1",null,null,null,null,null,null,null,"特定費用\n無償化対象外※2",null,null,null,null,null,"限度額※3\n(ア)×450円",null,null,null,null,null,null,"施設自由\n記載欄"]
[null,"年月",null,null,null,null,null,"提供期間及び\n　提供日数（ア）"]
[null,1,null,"年",10,null,"月",1,null,"日","～",31,null,"日","(a)",null,12000,null,null,null,null,"円",1500,null,null,null,null,"円","(b)",9000,null,null,null,null,"円"]
[null,null,null,null,null,null,null,"（うち",null,null,20,null,"日）"]
[null,"○標準的な利用時間（提供時間帯）は、札幌市に届出た確認申請書のとおり。（異なる場合は施設自由記載欄に記入）"]
[]
[null,"※1　利用料は無償化の対象となる利用料（特定子ども・子育て支援利用料）の額"]
[null,"※2　日用品、文房具、行事参加費、食材料費、通園送迎費等、無償化の対象とならない費用の額"]
[null,"※3　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,null,"上記のとおり、認定子どもに対し特定子ども・子育て支援を提供したこと、及び認定保護者から預かり保育事業の利用料として上記の金額を受領したことを証明します。",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,1,null,null,"年",11,null,"月",1,null,"日"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所名称",null,null,null,null,null,null,null,"■△幼稚園"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所所在地",null,null,null,null,null,null,null,"札幌市白石区菊水1条1丁目○番○号"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"施設・事業所の\n代表者職氏名",null,null,null,null,null,null,null,"給付　太郎"]
[]
[]
[null,null,"※上部の「提供証明書兼領収証」について、保護者が施設に無断で作成し又は改変を行ったときは、"]
[null,null,"　刑法上の罪に問われる場合があります。"]
[]
[null,"※以下、請求者（認定保護者）記入欄\n"]
[null,null,"（宛先）札幌市長",null,null,null,null,null,"施設等利用費請求書（預かり保育事業）　　"]
[]
[null,null,"私は、子ども・子育て支援法第30条の11第１項の規定に基づき、施設等利用費の給付について、下記の通り請求しますので、"]
[null,null,"別途申し出る償還払いの振込先口座に振り込んでください。なお、施設等利用費の審査にあたり、次の事項に同意します。"]
[null,null,"１．申請者と認定子どもが、札幌市内に居住していることを札幌市が住民基本台帳で確認すること。"]
[null,null,"２．実際に利用していることや、利用料の支払い状況を札幌市が対象施設や保護者に確認すること。"]
[null,null,"３．課税状況を札幌市が確認すること。"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"請求日",null,null,"令和",null,1,"年",11,null,"月",5,null,"日"]
[null,"1. 請求する保護者（認定保護者）"]
[null,"フリガナ",null,null,null,"サッポロ　イチロウ　　",null,null,null,null,null,null,null,null,null,null,null,"生年月日　",null,null,null,"昭和59",null,null,null,null,null,null,null,null,null,null,"年",11,null,"月",5,null,"日"]
[null,"氏　　　名",null,null,null,"札幌　一郎",null,null,null,null,null,null,null,null,null,"印",null,"現住所",null,null,null,"札幌市中央区南1条東1丁目3-122"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"日中連絡のつきやすい電話番号",null,null,null,"090-XXXX-XXXX      【 父･母・その他（　　　）】"]
[]
[null,"2. 利用した児童（認定子ども）　※児童ごとに請求書を分けてください。"]
[null,"フリガナ",null,null,null,"サッポロ　ハナ",null,null,null,null,null,null,null,null,null,null,null,"認定番号(新2号、新3号)",null,null,null,null,null,null,null,"0000000000"]
[null,"氏　　　名",null,null,null,"札幌　花",null,null,null,null,null,null,null,null,null,null,null,"生　年　月　日",null,null,null,null,null,null,null,"平成26",null,null,null,null,null,null,"年",1,null,"月",12,null,"日"]
[]
[]
[]
[null,"3. 在籍園の預かり保育事業の利用における施設等利用費の償還払い請求額"]
[null,"請求対象年月",null,null,null,null,null,1,null,"年",null,10,null,"月",null,"請求額※",null,null,null,null,null,9000,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,null,null,null,null,null,null,"※上記「提供内容並びに領収額及びその費用の内訳」における、\n　利用料(a)と限度額(b)を比較し、低い方の金額が請求額となります。"]
[]
[null,"「初めて請求・振込口座を変更」する方は別紙「振込口座申出書」もご提出ください。"]