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[]
[]
["別紙様式第 2 号（第 5 条第 2 項関係）"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"　年      月     日"]
["東京工業大学博物館資史料館部門長  殿"]
[]
[null,null,null,null,null,null,null,null,null,"氏名又は名称（法人その他の団体にあってはその名称及び代表者の氏名）"]
[]
[]
[null,null,null,null,null,null,null,null,null,"住所又は居所（法人その他の団体にあっては主たる事務所等の所在地）"]
[null,null,null,null,null,null,null,null,null,"〒　　　　　　　　　　　　　　　　　　　　　　TEL　　　(　　)"]
[]
[]
["簡易閲覧申込書"]
[]
[]
["東京工業大学博物館資史料館部門公文書室利用細則（平成 27 年博細則第１号）第５条に基づき，\n特定歴史公文書等（目録において利用制限の区分が全部利用可とされているものに限る。）\nの閲覧を下記のとおり申し込みます。"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記"]
[]
[" 閲覧を希望する特定歴史公文書等の名称等"]
[]
["No.",null,"識別番号",null,null,null,"目録に記載された特定歴史公文書等の名称",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"冊数",null,"利用方法"]
[]
[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,"閲覧"]
[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,"写しの交付"]
[2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"閲覧"]
[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,"写しの交付"]
[3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"閲覧"]
[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,"写しの交付"]
[4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"閲覧"]
[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,"写しの交付"]
[5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"閲覧"]
[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,"写しの交付"]
[]
["※写しの交付を希望する場合は，下記も記入してください。"]
[]
["写しの\n作成方法",null,null,null,"文書又は\n図画",null,null,null,null,null,"用紙への複写（A4・B4・A3）",null,null,null,null,null,null,null,null,null,null,"[No.       　   ]",null,null,null,null,null,"(計　　　　枚)"]
[]
[null,null,null,null,null,null,null,null,null,null,"スキャニングによるデジタル化\n（CD-R・DVD-R）",null,null,null,null,null,null,null,null,null,null,"[No.    　      ]",null,null,null,null,null,"(計　　　　枚)"]
[]
[null,null,null,null,null,null,null,null,null,null,"その他の方法(　　　　　　　　 ) ",null,null,null,null,null,null,null,null,null,null,"[No.    　      ]",null,null,null,null,null,"(計　　　　枚)"]
[]
[null,null,null,null,"電磁的\n記録",null,null,null,null,null,"電磁的記録の用紙への出力\n（A4・B4・A3  ）",null,null,null,null,null,null,null,null,null,null,"[No.    　      ]",null,null,null,null,null,"(計　　　　枚)"]
[]
[null,null,null,null,null,null,null,null,null,null,"電磁的記録の複写\n（CD-R・DVD-R）",null,null,null,null,null,null,null,null,null,null,"[No.    　      ]",null,null,null,null,null,"(計　　　　枚)"]
[]
[null,null,null,null,null,null,null,null,null,null,"その他の方法(　　　　　　　　 ) ",null,null,null,null,null,null,null,null,null,null,"[No.    　      ]",null,null,null,null,null,"(計　　　　枚)"]
[]
["写しの交付の方法",null,null,null,null,null,null,null,null,"室において交付",null,null,null,null,null,"郵送(送付先　　　　)",null,null,null,null,null,null,null,"その他の方法(　　　　　　)"]
[]
["（注）利用者が自らのカメラで撮影する場合は，別途「撮影申込書」を提出してください。"]