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["非税收入集中汇缴确认表"]
[{"$nulls":4},"第","号"]
["单位名称",null,null,"预算编码"]
["经办人",null,null,"联系电话"]
["申请日期","          年      月      日"]
["收费项目"]
["收费代码及名称"]
["收费标准"]
["管理类型","     □ 预算管理      □ 国有资本经营收益      □ 专户管理"]
["原收缴方式","     □ 直接缴户      □ 集中汇缴          □ 新增收费项目"]
["收缴对象","□ 个人             □ 单位"]
["年业务量（笔数）"]
["申请理由及依据"]
["执收单位签章",null,"主管部门签章",null,"财政部门签章"]
["负责人：",null,"负责人：",null,"负责人："]
[]
["经办人：",null,"经办人：",null,"经办人："]
["      （公章）",null,"      （公章）",null,"      （公章）"]
["            年   月   日",null,"            年   月   日",null,"            年   月   日"]