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臺北市立新興國中公物修繕申請表 
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身分別
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學生
申請人姓名／年級／班級
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請修項目
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請修日期
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請修數量
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請修物品位置
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損壞情形(請盡可能詳細填寫)
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導師
申請人姓名/班級
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請修項目
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請修日期
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請修數量
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請修物品位置
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損壞情形(請盡可能詳細填寫)
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行政同仁
潘信秀姓名
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行政同仁處室
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請修項目3b男廁 小便池隔板
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請修日期
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請修數量
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請修物品位置
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損壞情形(請盡可能詳細填寫)
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