听 证 笔 录
行政执法机关 ：
案 由：_____ ___________________
时 间： 年 月 日 时 分至 时 分
地 点：________________________
听证主持人：______________听证员：___ 记录员：
案件调查人（执法证号）：______________执法证号______________________
执法证号
当 事 人：_________________________法定代表人或负责人：_____________
地 址：_____________________________电 话：________________________
委托代理人：_________________________工作单位：______________________
委托代理人：_________________________工作单位：_______________________
证 人：
其他人员：____________________________________________________________
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__________________________________ 当事人签章： 委托代理人签名：
案件调查人员签名： 听证主持人签名：
记录员签名：
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