<style type="text/css"> .myTable,.myTable td { page-break-after:always; font-family:宋体;font-size:9pt; padding-right:0.5pt; padding-left:0.5pt; padding-top:0.5pt; padding-bottom:0.5pt; border-style:solid;border-width:1px 0 0 1px; } </style> <table cellspacing="0" cellpadding="0" border="0" class="myTable" style="border-width:0;width:555pt"> <tbody><tr style="height:0px"><td style="border-width:0;width:28pt"></td> <td style="border-width:0;width:95pt"></td> <td style="border-width:0;width:87pt"></td> <td style="border-width:0;width:103pt"></td> <td style="border-width:0;width:84pt"></td> <td style="border-width:0;width:76pt"></td> <td style="border-width:0;width:75pt"></td> </tr><tr style="height:55pt"> <td align="center" colspan="7" style="border-width:0"><font style="font-size:22pt;font-weight:bold;">住宅专项维修资金实际使用分摊表</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">一、小区名称</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="7"><font style="font-size:14pt;">&nbsp;&nbsp;&nbsp;&nbsp;名都华庭（西园里小区）</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">二、维修项目概况</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:18pt"> <td values="" style="border-width:0" bindtype="0" rowspan="5" colspan="7" datasource="" type="textarea' styles='line-height:37px"><font style="font-size:14pt;">　　1、名都华庭（西园里小区）名都华庭（西园里小区）601601单元电梯，已维修完<br>毕，结算金额：86,901.46元，审价费用：1576,合计：88,477.46； <br>　　2、名都华庭（西园里小区）西园里604,蠡溪路554,556604604单元电梯，已维修完<br>毕，结算金额：86,347.51元，审价费用：1576,合计：87,923.51。 <br>&nbsp;&nbsp;总合计：176,400.97元</font></td> </tr> <tr style="height:18pt"> </tr> <tr style="height:18pt"> </tr> <tr style="height:18pt"> </tr> <tr style="height:19pt"> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">三、施工日期</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　开始日期：2020-11-15；结束日期：2020-11-29。</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">四、施工单位</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　1、南通振兴电梯安装有限公司</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">五、验收结论</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:42pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　合格 <br>&nbsp;&nbsp;验收时间：2020年12月15日</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">六、参与验收人员</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　蒋红仙，无锡名都物业管理有限公司，南通振兴电梯安装有限公司</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">七、公示时间</font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> <td style="border-width:0"><font style="font-size:14pt;"></font></td> </tr> <tr style="height:14pt"> <td type="textarea' styles='line-height:37px" colspan="7" datasource="" values="" style="border-width:0" bindtype="0"><font style="font-size:14pt;">　　2021年06月11日至2021年06月11日。</font></td> </tr> <tr style="height:14pt"> <td style="border-width:0" colspan="2"><font style="font-size:14pt;font-weight:bold;">八、分摊清册</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td align="center">序号</td> <td align="center">房屋地址</td> <td align="center">房屋面积(㎡)</td> <td align="center">结算应拨金额(元)</td> <td align="center">自筹金额(元)</td> <td align="center">分摊金额(元)</td> <td align="center" style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">1</td> <td align="center">名都华庭（西园里小区）601单元1001室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">2</td> <td align="center">名都华庭（西园里小区）601单元1002室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">3</td> <td align="center">名都华庭（西园里小区）601单元1101室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">4</td> <td align="center">名都华庭（西园里小区）601单元1102室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">5</td> <td align="center">名都华庭（西园里小区）601单元1201室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">6</td> <td align="center">名都华庭（西园里小区）601单元1202室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">7</td> <td align="center">名都华庭（西园里小区）601单元1301室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">8</td> <td align="center">名都华庭（西园里小区）601单元1302室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">9</td> <td align="center">名都华庭（西园里小区）601单元1401室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">10</td> <td align="center">名都华庭（西园里小区）601单元1402室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">11</td> <td align="center">名都华庭（西园里小区）601单元1501室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">12</td> <td align="center">名都华庭（西园里小区）601单元1502室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">13</td> <td align="center">名都华庭（西园里小区）601单元1601室</td> <td align="center">280.3400</td> <td align="center">5,442.58</td> <td align="center">0</td> <td align="center">5,442.58</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">14</td> <td align="center">名都华庭（西园里小区）601单元1602室</td> <td align="center">212.7100</td> <td align="center">4,129.51</td> <td align="center">0</td> <td align="center">4,129.51</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">15</td> <td align="center">名都华庭（西园里小区）601单元301室</td> <td align="center">170.4200</td> <td align="center">3,308.50</td> <td align="center">0</td> <td align="center">3,308.50</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">16</td> <td align="center">名都华庭（西园里小区）601单元302室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">17</td> <td align="center">名都华庭（西园里小区）601单元401室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">18</td> <td align="center">名都华庭（西园里小区）601单元402室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">19</td> <td align="center">名都华庭（西园里小区）601单元501室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">20</td> <td align="center">名都华庭（西园里小区）601单元502室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center" style="border-width:1px 0 1px 1px">21</td> <td align="center" style="border-width:1px 0 1px 1px">名都华庭（西园里小区）601单元601室</td> <td align="center" style="border-width:1px 0 1px 1px">172.4200</td> <td align="center" style="border-width:1px 0 1px 1px">3,347.32</td> <td align="center" style="border-width:1px 0 1px 1px">0</td> <td align="center" style="border-width:1px 0 1px 1px">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> </tbody></table> <table cellspacing="0" cellpadding="0" border="0" class="myTable" style="border-width:0;width:555pt"> <tbody><tr style="height:0px"><td style="border-width:0;width:28pt"></td> <td style="border-width:0;width:95pt"></td> <td style="border-width:0;width:87pt"></td> <td style="border-width:0;width:103pt"></td> <td style="border-width:0;width:84pt"></td> <td style="border-width:0;width:76pt"></td> <td style="border-width:0;width:75pt"></td> </tr><tr style="height:14pt"> <td align="center">22</td> <td align="center">名都华庭（西园里小区）601单元602室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">23</td> <td align="center">名都华庭（西园里小区）601单元701室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">24</td> <td align="center">名都华庭（西园里小区）601单元702室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">25</td> <td align="center">名都华庭（西园里小区）601单元801室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">26</td> <td align="center">名都华庭（西园里小区）601单元802室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">27</td> <td align="center">名都华庭（西园里小区）601单元901室</td> <td align="center">172.4200</td> <td align="center">3,347.32</td> <td align="center">0</td> <td align="center">3,347.32</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">28</td> <td align="center">名都华庭（西园里小区）601单元902室</td> <td align="center">140.3800</td> <td align="center">2,725.31</td> <td align="center">0</td> <td align="center">2,725.31</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">29</td> <td align="center">名都华庭（西园里小区）604单元1001室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">30</td> <td align="center">名都华庭（西园里小区）604单元1002室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">31</td> <td align="center">名都华庭（西园里小区）604单元1101室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">32</td> <td align="center">名都华庭（西园里小区）604单元1102室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">33</td> <td align="center">名都华庭（西园里小区）604单元1201室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">34</td> <td align="center">名都华庭（西园里小区）604单元1202室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">35</td> <td align="center">名都华庭（西园里小区）604单元1301室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">36</td> <td align="center">名都华庭（西园里小区）604单元1302室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">37</td> <td align="center">名都华庭（西园里小区）604单元1401室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">38</td> <td align="center">名都华庭（西园里小区）604单元1402室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">39</td> <td align="center">名都华庭（西园里小区）604单元1501室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">40</td> <td align="center">名都华庭（西园里小区）604单元1502室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">41</td> <td align="center">名都华庭（西园里小区）604单元1601室</td> <td align="center">198.3000</td> <td align="center">4,080.56</td> <td align="center">0</td> <td align="center">4,080.56</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">42</td> <td align="center">名都华庭（西园里小区）604单元1602室</td> <td align="center">217.5400</td> <td align="center">4,476.61</td> <td align="center">0</td> <td align="center">4,476.61</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">43</td> <td align="center">名都华庭（西园里小区）604单元202室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">44</td> <td align="center">名都华庭（西园里小区）604单元301室</td> <td align="center">139.1300</td> <td align="center">2,862.98</td> <td align="center">0</td> <td align="center">2,862.98</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">45</td> <td align="center">名都华庭（西园里小区）604单元302室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">46</td> <td align="center">名都华庭（西园里小区）604单元401室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">47</td> <td align="center">名都华庭（西园里小区）604单元402室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">48</td> <td align="center">名都华庭（西园里小区）604单元501室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">49</td> <td align="center">名都华庭（西园里小区）604单元502室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">50</td> <td align="center">名都华庭（西园里小区）604单元601室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">51</td> <td align="center">名都华庭（西园里小区）604单元602室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">52</td> <td align="center">名都华庭（西园里小区）604单元701室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">53</td> <td align="center">名都华庭（西园里小区）604单元702室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">54</td> <td align="center">名都华庭（西园里小区）604单元801室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">55</td> <td align="center">名都华庭（西园里小区）604单元802室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">56</td> <td align="center">名都华庭（西园里小区）604单元901室</td> <td align="center">141.1500</td> <td align="center">2,904.54</td> <td align="center">0</td> <td align="center">2,904.54</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td align="center">57</td> <td align="center">名都华庭（西园里小区）604单元902室</td> <td align="center">144.5700</td> <td align="center">2,974.92</td> <td align="center">0</td> <td align="center">2,974.92</td> <td style="border-width:0 0 0 1px"></td> </tr> <tr style="height:14pt"> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:1px 0 0 0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td align="right" colspan="3" style="border-width:0"><font style="font-size:14pt;">申请人（盖章）</font></td> <td style="border-width:0"></td> <td style="border-width:0"></td> </tr> <tr style="height:14pt"> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0"></td> <td style="border-width:0" colspan="2"><font style="font-size:14pt;">年&nbsp;&nbsp;&nbsp;&nbsp;月&nbsp;&nbsp;&nbsp;&nbsp;日</font></td> </tr> </tbody></table>