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現場檢查（勘驗）筆錄

時間：      年    　月    　日   　時 　  分至   　時 　  分

檢查（勘驗）地點：                                         

當事人：                                                   　

檢查（勘驗）機關：                            　　        

檢查（勘驗）人員：               執法證件號：              

                                                            

記錄人：                                                   

現場檢查（勘驗）情況：                                     

                                                            

                                                            

                                                           

                                                            

                                                           

                                                           

                                                           

                                                            

當事人簽名或蓋章：             （見證人簽名或蓋章：        ）

執法人員簽名或蓋章：                      

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筆 錄 紙

                                                           

                                                           

                                           　              

                                             　            

                                                            

                                                             

                                                           

                                                           

                                           　              

                                              　           

                                                  　       

                                           　              

                                           　              

                                                           

                                                            

當事人簽名或蓋章：            （見證人簽名或蓋章：        ）

執法人員簽名或蓋章：                      

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