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[null,null,null,"所属",null,null,null,null,null,null,null,"職名",null,null,null,null,null,null,"住所","(郵便番号",null,null,null,null,"−",null,null,null,")",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名","(フリガナ)",null,null,null,null,null,null,null,null,null,null,"整理\n番号"]
[null,"甲欄"]
[]
[null,"乙欄"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(生年月日",null,"明・大・昭・平・令",null,null,null,"年",null,"月",null,"日)"]
[]
[null,null,null,"区分","月区分","支給\n月日",null,"総支給金額",null,null,null,null,"社会保険\n料等の\n控除額",null,null,null,"社会保険料等\n控除後の給与\n等の金額",null,null,null,null,"扶養親\n族等の\n数",null,"算出税額",null,null,null,"年末調整\nによる過\n不足税額",null,null,"差引\n徴収税額",null,null,null,"前年の年末調整に基づき繰り越した過不足税額"]
[]
[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,null,null,null,null,null,"同上の税額につき還付\n又は徴収した月区分",null,null,null,null,null,"月別",null,"還付又は徴収した税額",null,null,null,null,"差引残高",null,null,null,"月別",null,"還付又は徴収した税額",null,null,null,null,"差引残高"]
[]
[]
[null,"令和"]
[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,null,null,null,null,null,"扶養控除等の申告","申告の有無","源泉控除\n対象配偶者",null,null,"一般の控除対象扶養親族",null,null,"特定扶\n養親族",null,null,"老人扶養親族",null,null,null,null,null,"障害者等\n(該当するものを○で囲んでください。)",null,null,null,null,null,null,"従たる給与から控除する控除対象配偶者と控除対象扶養親族の合計数",null,null,"配偶者の有無"]
[null,null,null,"給　　料　　・　　手　　当　　等",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同居老親等",null,null,"その他"]
[]
[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,null,null,null,null,null,null,null,"当初",null,null,"当初",null,null,"当初",null,null,"当初",null,null,"当初",null,null,"当初",null,null,"・一般の障害者\n本人・配・扶(    人)\n・特別障害者\n本人・配・扶(    人)\n・同居特別障害者\n配・扶(    人)\n・寡 婦・特別の寡婦\n・寡 夫\n・勤労学生"]
[null,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,null,null,null,null,null,null,null,null,null,null,null,null,"有　・　無",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人"]
[null,"年",null,null,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,null,null,null,null,null,null,null,null,null,null,null,"有・無","　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,null,null,null,null,"当初",null,null,"有・無"]
[null,"分"]
[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,null,null,null,null,null,null,null,"有　・　無",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,null,null,null,null,"　　　　人"]
[]
[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,null,null,null,null,null,null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,"　　月　　日",null,null,null,null,null,null,"　　月　　日"]
[null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,null,"有　・　無",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,"　　　　人",null,null,null,null,null,null,"　　　　人"]
[null,"給与所得","退職所得"]
[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,null,null,null,null,null,"年　　　末　　　調　　　整","区　　分",null,null,null,null,null,null,null,null,"金　　額",null,null,null,null,null,null,null,null,"税　　額"]
[]
[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,null,null,null,null,null,null,"給与・手当等",null,null,null,null,null,null,null,null,"①",null,null,null,null,null,null,null,null,"③"]
[null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,"賞　与　等",null,null,null,null,null,null,null,null,"④",null,null,null,null,null,null,null,null,"⑥"]
[]
[]
[null,"に 対 す る 所 得 税 源 泉 徴 収 簿",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,null,null,null,null,"計",null,null,null,null,null,null,null,null,"⑦",null,null,null,null,null,null,null,null,"⑧"]
[null,null,null,null,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,null,null,null,null,null,null,null,null,null,null,null,"　給与所得控除後の給与等の金額　",null,null,null,null,null,null,null,null,"⑨"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※　所得金額調整控除申告書の"]
[]
[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,null,null,null,null,null,null,"所得金額調整控除額（※）\n((⑦-8,500,000円)×10％、マイナスの場合は0)",null,null,null,null,null,null,null,null,"⑩","(1,000円未満切り上げて、最高15,000円)",null,null,null,null,null,null,null,"提出がある場合は⑩に記載。"]
[null,null,null,null,6]
[]
[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,null,null,null,null,null,null,"給与所得控除後の給与等の金額\n(調整控除後)(⑨−⑩)",null,null,null,null,null,null,null,null,"⑪",null,null,null,null,null,null,null,null,"配偶者の合計所得金額"]
[]
[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,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,null,null,"円)"]
[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,null,null,null,null,null,null,"社会保\n険料等\n控除額",null,"給与等からの控除分(②+⑤)",null,null,null,null,null,null,"⑫"]
[null,null,null,null,7,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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"旧長期損害保険料支払額"]
[]
[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,null,null,null,null,null,null,null,null,"申告による社会保険料の控除分",null,null,null,null,null,null,"⑬",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,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,null,null,null,null,null,null,null,null,null,"⑫のうち小規模企業共済等掛金の金額"]
[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,null,null,null,null,null,null,null,null,"　申告による小規模企業　\n　共済等掛金の控除分　",null,null,null,null,null,null,"⑭"]
[null,null,null,null,8]
[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,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,null,null,"円)"]
[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,null,null,null,null,null,null,"　生命保険料の控除額　",null,null,null,null,null,null,null,null,"⑮"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"⑬のうち国民年金保険料等の金額"]
[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,null,null,null,null,null,null,"　地震保険料の控除額　",null,null,null,null,null,null,null,null,"⑯"]
[]
[null,null,null,null,9,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,null,"　配偶者（特別）控除額",null,null,null,null,null,null,null,null,"⑰",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"扶養控除額及び\n 障害者等の控除額の合計額",null,null,null,null,null,null,null,null,"⑱"]
[]
[]
[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,null,null,null,null,null,null,"基礎控除額",null,null,null,null,null,null,null,null,"⑲"]
[null,null,null,null,10]
[]
[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,null,null,null,null,null,null,"所得控除額の合計額\n(⑫+⑬+⑭+⑮+⑯+⑰+⑱+⑲)",null,null,null,null,null,null,null,null,"⑳"]
[]
[]
[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,null,null,null,null,null,null,"差引課税給与所得金額(⑪−⑳)\n及び算出年税額",null,null,null,null,null,null,null,null,"㉑","(1,000円未満切捨て)",null,null,null,null,null,null,null,"㉒"]
[null,null,null,null,11]
[]
[]
[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,null,null,null,null,null,null,"　(特定増改築等)住宅借入金等特別控除額　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉓"]
[]
[]
[null,null,null,null,12,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,null,"　年調所得税額(㉒−㉓、マイナスの場合は０)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉔"]
[]
[]
[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,null,null,null,null,null,null,"　年 調 年 税 額 （㉔ × 1 0 2 . 1 % )　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉕","(100円未満切捨て)"]
[]
[]
[null,null,null,null,"計",null,null,"①",null,null,null,null,"②",null,null,null,null,null,null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,"　差引超過額又は不足額(㉕−⑧)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉖"]
[]
[]
[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,null,null,null,null,null,null,"超過額\nの精算",null,null,"　本年最後の給与から徴収する税額に充当する金額　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉗"]
[null,null,null,"賞与等",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(税率",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,null,null,null,null,null,null,null,null,null,null,null,"　未払給与に係る未徴収の税額に充当する金額　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉘"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(税率",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,null,null,null,null,null,null,null,null,null,null,null,"　差引還付する金額　(㉓−㉔−㉕)　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉙"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(税率",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,null,null,null,null,null,null,null,null,null,null,null,"同上の\nうち",null,"　本年中に還付する金額　",null,null,null,null,null,null,null,null,null,null,null,null,"㉚"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(税率",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,null,null,null,null,null,null,null,null,null,null,null,null,null,"　翌年において還付する金額　",null,null,null,null,null,null,null,null,null,null,null,null,"㉛"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(税率",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,null,null,null,null,null,null,null,null,"不足額\nの精算",null,null,"　本年最後の給与から徴収する金額　　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉜"]
[null,null,null,null,"計",null,null,"④",null,null,null,null,"⑤",null,null,null,null,null,null,null,null,null,null,"⑥"]
[]
[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,null,null,null,null,null,null,null,null,null,"　翌年に繰り越して徴収する金額　",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㉝"]

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[null,"給 料 ・ 手 当 等 の 支 給 金 額 の 内 訳",null,"月\n区分",null,"支給\n月日",null,"基 本 給",null,null,null,"家族手当",null,null,"手当",null,null,"手当",null,null,"手当",null,null,"手当",null,null,"手当",null,null,"総支給金額",null,null,null,"給与等から控\n除された小規\n模企業共済等\n掛金の金額",null,null,null,"前月中に通常の給与を支給していな\nかった場合に支給する賞与の税額計算"]
[]
[]
[]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,"区     分",null,null,null,null,null,null,"第 1 回",null,null,null,null,"第 2 回",null,null,null,null,"第 3 回"]
[]
[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,null,null,null,null,null,null,null,null,"支 給 月 日",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険料等控除後\nの賞与の金額",null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,"①✕1/6又は1/12",null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,"②に対する月額表に\n定める税額",null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,"算出税額\n(③✕6又は12)"]
[]
[]
[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,null,null,null,null,null,null,null,null,"支給する賞与の金額が、前月中に支給した通常\nの給与の10倍を超える場合の賞与の税額計算"]
[]
[]
[]
[]
[]
[]
[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,null,null,null,null,null,null,null,null,"区     分",null,null,null,null,null,null,"第 1 回",null,null,null,null,"第 2 回",null,null,null,null,"第 3 回"]
[]
[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,null,null,null,null,null,null,null,null,"支 給 月 日",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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"社会保険料等控除後\nの賞与の金額",null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,"①✕1/6又は1/12",null,null,null,null,null,"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,null,null,null,null,null,null,null,null,null,null,null,null,null,"②＋前月の「社会保険料等\n控除後の給与等の金額」",null,null,null,null,null,"③"]
[null,"災害減免法\nによる徴収\n猶予関係",null,null,null,"申告書の受付月日",null,null,null,null,null,null,null,"徴収猶予許可月日",null,null,null,null,null,null,null,"徴収猶予期間",null,null,null,null,null,null,null,"雑損失又は繰越雑損失が\nある場合の徴収猶予限度額"]
[]
[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,null,null,null,null,null,null,null,null,"③に対する月額表に\n定める税額",null,null,null,null,null,"④"]
[]
[]
[null,null,null,null,null,null,null,null,null,"月",null,null,"日",null,null,null,null,"月",null,null,"日","自",null,null,null,"月",null,null,"日",null,null,null,null,null,null,null,null,"④−前月の「社会保険料等控除後の\n給与等の金額」に対する月額表の税額",null,null,null,null,null,"⑤"]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,null,null,"月",null,null,"日",null,null,null,null,null,null,null,null,"算出税額\n(⑤✕6又は12)"]
[]
[]
[null,"退 職 所 得 の 税 額 計 算",null,"就 職\n年 月 日",null,null,"・　 ・",null,null,"退 職\n年 月 日",null,null,"・　 ・",null,null,"退職所得控除額の計算","勤続年数及びその\n勤続年数に応ずる\n控除の金額",null,null,null,null,null,"自",null,"年",null,"月",null,"日","(",null,"年)","㋑",null,null,null,null,null,"特定役員退職所得控除額の計算","特定役員等\n勤続年数",null,null,"自",null,"年",null,"月",null,"日","A",null,null,"平成２８〜令和元年中の退職手当の有無等"]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,"年",null,"月",null,"日","(",null,"年)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,"年",null,"月",null,"日"]
[]
[null,null,null,"役員就任\n年 月 日",null,null,"・　 ・",null,null,"役員退任\n年 月 日",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,"一般勤続期間",null,null,"自",null,"年",null,"月",null,"日"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"上の勤続年数に通算\nされた前の退職手当\nについての勤続年数\n及びその勤続年数に\n応ずる控除の金額",null,null,null,null,null,"自",null,"年",null,"月",null,"日","(",null,"年)","㋺"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,"年",null,"月",null,"日"]
[]
[]
[null,null,null,"支払確定\n年 月 日",null,null,"・　 ・",null,null,"支 給\n年 月 日",null,null,"・　 ・",null,null,null,null,null,null,null,null,null,"至",null,"年",null,"月",null,"日",null,null,null,null,null,null,null,null,null,null,"重複勤続年数",null,null,"自",null,"年",null,"月",null,"日","B"]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,"至",null,"年",null,"月",null,"日","(",null,"年)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"差引退職所得控除額\n(㋑−㋺)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㋩"]
[]
[null,null,null,"退 職\n区 分",null,null,"普通・障害",null,null,"特定役員\n退職手当\n等の有無",null,null,"有・無",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,"特定役員退職所得控除額\n(40万円×(A−B)+20万円×B)"]
[]
[]
[]
[]
[]
[null,null,null,1,"通常の場合",null,null,null,null,null,null,"区分",null,null,"支給金額",null,null,null,"①",null,null,null,null,"退職所得控除額",null,null,null,"②",null,null,null,null,"課税退職所得金額\n((①−②)✕1/2)\n又は(①−②)",null,null,null,"③",null,null,null,null,"③に対する税額\n（申告がないときは、①✕20.42％）"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"一般\n特定役員"]
[]
[]
[null,null,null,2,"追加支給\nをする場合",null,null,null,null,null,null,"区分",null,null,"追加支給の\n金 額",null,null,null,"①",null,null,null,null,"前に支給した\n退職手当",null,null,null,"②",null,null,null,null,"合 計 支 給 額\n(①＋②)",null,null,null,"④",null,null,null,null,"課税退職所得金額\n((④−⑤)✕1/2)\n又は(④−⑤)",null,null,null,"⑥",null,null,null,null,"①から徴収する\n税額 (⑦−③)"]
[]
[null,null,null,null,null,null,null,null,null,null,null,"一般\n\n特定役員"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"前回、今回とも\n申告がないとき\nは、①×20.42%"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同上の徴収税額",null,null,null,"③",null,null,null,null,"同上の退職所得\n控 除 額",null,null,null,"⑤",null,null,null,null,"⑥に対する税額",null,null,null,"⑦"]
[]
[]
[]
[null,null,null,3,"本年中に他から\n受けた退職手当\nが あ る 場 合",null,null,null,null,null,null,"区分",null,null,"支給金額",null,null,null,"①",null,null,null,null,"本年中に他から\n受けた退職手当",null,null,null,"②",null,null,null,null,"合 計 支 給 額\n(①＋②)",null,null,null,"④",null,null,null,null,"課税退職所得金額\n((④−⑤)✕1/2)\n又は(④−⑤)",null,null,null,"⑥",null,null,null,null,"①から徴収する\n税額 (⑦−③)"]
[null,"受給に\n関する\n申告書\nの提出"]
[null,null,null,null,null,null,null,null,null,null,null,"一般\n\n特定役員"]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申告がないとき\nは、①×20.42%"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"同上の徴収税額",null,null,null,"③",null,null,null,null,"同上の退職所得\n控 除 額",null,null,null,"⑤",null,null,null,null,"⑥に対する税額",null,null,null,"⑦"]
[]
[]
[]
[null,null,null,4,"特定役員退職手当等\nと一般退職手当等の\n両方を支給する場合",null,null,null,null,null,null,null,null,null,"支給金額",null,null,null,"①",null,null,null,null,"一般退職手\n当等の金額",null,null,null,"②",null,null,null,null,"退職所得控除額",null,null,null,"④",null,null,null,null,"一般退職所得控除額\n(④−⑤)",null,null,null,"⑥",null,null,null,null,"⑦に対する税額"]
[]
[]
[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,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"申告がないとき\nは、①×20.42%"]
[null,"有・無",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"特定役員退職手当\n等の金額(①−②)",null,null,null,"③",null,null,null,null,"特定役員退職\n所得控除額",null,null,null,"⑤",null,null,null,null,"課税退職所得金額\n((②−⑥)×1/2+(③−⑤))",null,null,null,"⑦"]

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