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[null,"様式第12号（第10条関係）"]
[]
[null,"０円空き家情報登録リスト"]
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[null,"登録№",{"$nulls":4},"分　類",null,"土地　・　建物",null,null,null,"□ 無償譲渡"]
[null,"物件住所地",null,"  北斗市",{"$nulls":4},"家屋状態の目安",null,null,null,"☆☆☆☆☆"]
[null,"物件\n所有者\n管理者",null,"〒　　　　",null,null,"住　所"]
[null,null,null,"氏　名",{"$nulls":6},"ＴＥＬ"]
[null,null,null,"携　帯",{"$nulls":6},"ＦＡＸ"]
[null,null,null,"eメール",null,"　　　　　　　　　　   　　　　＠"]
[null,"土地所有者",null,"〒　　　　",null,null,"住　所"]
[null,null,null,"氏　名",{"$nulls":6},"ＴＥＬ"]
[null,"その他\n連絡先",null,"〒 ",null,null,"住　所"]
[null,null,null,"連絡先名",{"$nulls":6},"ＴＥＬ"]
[null,"登記事項","物件","所在",{"$nulls":6},"建築年月日"]
[null,null,null,"種類",null,null,"構造",null,null,null,"面積","1階　　㎡、2階　　㎡、その他　　㎡"]
[null,null,null,"所有者","住所",{"$nulls":6},"氏名"]
[null,null,null,"所有権以外の権利"]
[null,null,"土地","所在・地番"]
[null,null,null,"地目",null,null,"地積"]
[null,null,null,"所有者","住所",{"$nulls":6},"氏名"]
[null,null,null,"所有権以外の権利"]
[null,"物件の概要","間取り",null,"１階","□ 居間（ 　　 ）畳　　□ 台所　　□ 風呂　　□ トイレ　　□ その他（　 　　）"]
[{"$nulls":5},"□ 洋室（　　　）畳（　　　）畳",{"$nulls":4},"□ 和室（　　　）畳（　　　）畳（　　　）畳"]
[{"$nulls":4},"２階","□ 洋室（　　　）畳（　　　）畳",{"$nulls":4},"□ 和室（　　　）畳（　　　）畳（　　　）畳"]
[{"$nulls":5},"□ その他（　　　）　　　"]
[null,null,"補修の要否",null," □ 補修は不要 　　□ 多少の補修必要　　□ 大幅な補修必要 　　□ 現在補修中"]
[null,null,"補修の費用負担",null," □ 所有者負担　　 □ 入居者負担　　 □ その他（　　　　　　　　　　）"]
[null,"利用状況"," □ 放置　（　　　）年",null,null,null,"設備状況","電　気",null,"□ 引き込み済み　　□ その他（　　　　）"]
[null,null," □ 別荘",{"$nulls":4},"ガ　ス",null,"□ プロパンガス　　 □ その他（　　　　）"]
[null,null," □ その他",{"$nulls":4},"風　呂",null,"□ ガス　□ 灯油　□ 電気 　□ その他（　　　　）"]
[{"$nulls":7},"水　道",null,"□ 上水道　 □ 簡易水道　□ その他（　　　 ）"]
[null,"主要施設等への距離","□駅 ",null,null,"km",null,"下水道",null,"□ 下水道　 □ 浄化槽　 □ その他（　　　　）"]
[null,null,"□バス停",null,null,"km",null,"トイレ",null,"□ 水洗　 □ 汲取り　／　□ 和　 □ 洋"]
[null,null,"□市役所",null,null,"km",null,"車　庫",null,"□ 有　□ 無",null,"物　置",null,"□ 有　□ 無"]
[null,null,"□病院",null,null,"km",null,"庭",null,"□ 有　□ 無",null,"その他"]
[null,null,"□消防署",null,null,"km","　【間　取】",null,"（別紙可）",null,null,"　【写　真】",null,"（別紙可）"]
[null,null,"□警察署",null,null,"km"]
[null,null,"□保育園",null,null,"km"]
[null,null,"□小学校",null,null,"km"]
[null,null,"□中学校",null,null,"km"]
[null,null,"□公営温泉",null,null,"km"]
[null,null,"□公園",null,null,"km"]
[null,null,"□スーパー",null,null,"km"]
[null,null,"□ﾎｰﾑｾﾝﾀｰ",null,null,"km"]
[null,null,"□コンビニ",null,null,"km"]
[null,"都市計画",null,"□ 都市計画区域 【□市街化区域（用途：　　　　　　　）　□市街化調整区域】 、 □ 都市計画区域外　 "]
[null,"特記\n事項"]
[null,null,"※過去に事件、事故、火災等が発生した物件については、必ずその旨をご記入願います。"]
[null,"受付日",null,"　　　　　年　　　月　　　日",{"$nulls":5},"現地確認日",null,"　　　　　年　　　月　　　日"]
[null,"登録日",null,"　　　　　年　　　月　　　日",{"$nulls":5},"有 効 期 日",null,"　　　　　年　　　月　　　日"]
[null,"登録抹消日",null,"　　　　　年　　　月　　　日",{"$nulls":5},"□譲渡契約成立　□登録取消　□その他（　　　　）"]