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听  证  笔  录

听证案由：

听证时间：    年      月     日自      时      分至       时     分

听证地点：                                               

听证主持人：                     职务：                 听证记录员：

听证申请人：                     地址：

法定代表人：                     电话：

委托代理人：                     工作单位：               职务：

案件调查人员：                   工作单位：               职务：

其他参与人员：

听  证  内   容

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    当事人____________（签字）               调查人___________（签字）
                ____________（签字）                           ___________（签字）
                ____________（签字）                           ___________（签字）

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