<div>&#160;</div>
<div align="center"><font size="5"><strong>公共活动场所使用申请单</strong></font></div>
<div align="center">
<table tabindex="65535" class="xdLayout" bordercolor="#ffffff" border="1" style="word-wrap: break-word; border-top: medium none; border-right: medium none; border-collapse: collapse; table-layout: fixed; border-bottom: medium none; border-left: medium none; width: 630px">
    <colgroup><col style="width: 90px" /><col style="width: 120px" /><col style="width: 90px" /><col style="width: 120px" /><col style="width: 90px" /><col style="width: 120px" /></colgroup>
    <tbody valign="top">
        <tr style="min-height: 25px">
            <td colspan="6" style="border-top: #000000 1pt; border-right: #000000 1pt; vertical-align: middle; border-bottom: #000000 1.5pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1pt; padding-right: 1px">
            <div>&#160;</div>
            </td>
        </tr>
        <tr style="min-height: 40px">
            <td style="border-top: #000000 1.5pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">申请部门</font></div>
            </td>
            <td style="border-top: #000000 1.5pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">{DATA_1}</font></div>
            </td>
            <td style="border-top: #000000 1.5pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">申请人</font></div>
            </td>
            <td style="border-top: #000000 1.5pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">{DATA_2}</font></div>
            </td>
            <td style="border-top: #000000 1.5pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">使用场所</font></div>
            </td>
            <td style="border-top: #000000 1.5pt solid; border-right: #000000 1.5pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">{DATA_3}</font></div>
            </td>
        </tr>
        <tr style="min-height: 40px">
            <td style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">占用时间</font></div>
            </td>
            <td colspan="3" style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="text-align: left"><font face="宋体" style="font-size: 11pt">{DATA_4}{OTHER_1}至{DATA_5}{OTHER_2}</font></div>
            </td>
            <td style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">参加人数</font></div>
            </td>
            <td style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">{DATA_6}</font></div>
            </td>
        </tr>
        <tr style="min-height: 78px">
            <td style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">事由</font></div>
            </td>
            <td colspan="5" style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: top; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="line-height: 1.5"><font face="宋体" style="font-size: 11pt">{DATA_7}</font></div>
            </td>
        </tr>
        <tr style="min-height: 60px">
            <td rowspan="2" style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">部门经理</font></div>
            </td>
            <td colspan="5" style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: top; border-bottom: #000000 1pt; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="line-height: 1.5"><font face="宋体" style="font-size: 11pt">{DATA_8}</font></div>
            </td>
        </tr>
        <tr style="min-height: 25px">
            <td colspan="5" style="border-top: #000000 1pt; border-right: #000000 1.5pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="text-align: right"><font face="宋体" style="font-size: 11pt">签字：{DATA_9}</font></div>
            </td>
        </tr>
        <tr style="min-height: 60px">
            <td rowspan="2" style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">行政经理</font></div>
            </td>
            <td colspan="5" style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: top; border-bottom: #000000 1pt; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="line-height: 1.5"><font face="宋体" style="font-size: 11pt">{DATA_10}</font></div>
            </td>
        </tr>
        <tr style="min-height: 25px">
            <td colspan="5" style="border-top: #000000 1pt; border-right: #000000 1.5pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="text-align: right"><font face="宋体" style="font-size: 11pt">签字：{DATA_11}</font></div>
            </td>
        </tr>
        <tr style="min-height: 60px">
            <td rowspan="2" style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">用后检查</font></div>
            </td>
            <td colspan="5" style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: top; border-bottom: #000000 1pt; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="line-height: 1.5"><font face="宋体" style="font-size: 11pt">{DATA_12}</font></div>
            </td>
        </tr>
        <tr style="min-height: 25px">
            <td colspan="5" style="border-top: #000000 1pt; border-right: #000000 1.5pt solid; vertical-align: middle; border-bottom: black 1pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="text-align: right"><font face="宋体" style="font-size: 11pt">检查人签字：{DATA_13}</font></div>
            </td>
        </tr>
        <tr style="min-height: 56px">
            <td style="border-top: black 1pt solid; border-right: black 1pt solid; vertical-align: middle; border-bottom: #000000 1.5pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: #000000 1.5pt solid; padding-right: 1px">
            <div align="center"><font face="宋体" style="font-size: 11pt">备注</font></div>
            </td>
            <td colspan="5" style="border-top: black 1pt solid; border-right: #000000 1.5pt solid; vertical-align: top; border-bottom: #000000 1.5pt solid; padding-bottom: 1px; padding-top: 1px; padding-left: 1px; border-left: black 1pt solid; padding-right: 1px">
            <div style="line-height: 1.5"><font face="宋体" style="font-size: 11pt">{DATA_14}</font></div>
            </td>
        </tr>
    </tbody>
</table>
</div>