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當事人陳述和申辯筆錄

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陳述申辯人：                  案件承辦人員：               

陳述和申辯地點：                  記錄人：                  

陳述和申辯時間：         年   月   日   時   分至   時   分。

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陳述申辯人（簽名或蓋章）：                    

記錄人（簽名或蓋章）：             

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