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[null,null,null,"（様式３別紙）"]
[]
["使用した認定登記基準点"]
[]
["記入に関する注意事項"]
["　※使用目的欄には、次のいずれかに該当する番号を○で囲んでください。"]
["　　１　地積測量図作成のため使用した点"]
["　　２　点検のために使用した点"]
["　　３　異常のため使用を断念した点"]
["　　４　その他"]
["　※地積測量図に使用した場合は、備考欄に所在地番を記入すること。"]
[]
["使用点名","使用年月日","使用目的","備　　考"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]
[null,"　　　年　　月　　日","１・２・３・４"]

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