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报销部门: 20 年 月 日填 单据及附件共 页
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<td width="70%" > 用 途 </td>
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<td> 合 计 </td>
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<td align="left" colspan="2">金额大写:</td>
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<td>备<br><br>注</td>
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<td>领<br>导<br>审<br>批</td>
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<td>原借款: 元</td>
<td>应退余额: 元</td>
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