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聽證筆錄

                      

案由：                                                                      

時間：    年   月   日   時   分至   時   分

地點：                                                      

聽證主持人：                   記錄人：                    

調查人員：                     執法證號：         ;         

                               執法證號：              ;     

當  事  人：                   法定代表人或負責人：                 

地      址：                   電話：                       

委托代理人：                   工作單位：                 

委托代理人：                   工作單位：                  

證      人：            ;       其他人員：                   

聽證筆錄：                                                                                                      

                                                                              

當事人簽名：                              年  月  日

委托代理人簽名：       ;                   年  月  日                     ;                                                                          

調查人員簽名：            、              年  月  日                                            

聽證主持人：                              年  月  日

記錄人簽名：                              年  月  日                                                       

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（在有關參加人對聽證筆錄審閱后，應注明“上述聽證筆錄內容已閱，記錄屬實。”）                                                                     

當事人簽名：                        ;      年  月  日

委托代理人簽名：                          年  月  日  ;                                                                                      ;       

調查人員簽名：            、         ;     年  月  日               ;                             

聽證主持人簽名：                          年  月  日

記錄人簽名：    ;                          年  月  日                                           ;     ;       

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