调 查(询 问)笔 录

  查(询 问)笔

                                                                                      

 由:                                                       

调查(询问)时间:                     分至      分。

调查(询问)地点:                                             

被调查(询问)人:             性别:   民族:      身份证号码:               

工作单位:                             职务或职业:           电话:           

 址:                                邮编:           与本案关系:          

调查(询问)人:                                      记录人:               

工作单位:                                                                     

执法人员表明身份、出示证件及为被调查(询问)人确认的记录: 我们是××机关的行政执法人员,这是我们的执法证件(向当事人出示证件,并记录持证人员姓名和证件号),请您过目确认。                

被调查(询问)人对执法人员出示证件、表明身份的确认记录:                           

告知陈述(申辩)和申请回避的权利:                                                                                        

                                                                                   

询问内容:                                                                                     

                                                                                          

                                                                                              

                                                                                                          

                                                                                        

  (以下是调查(询问)笔录尾页)                                                                                             

应注明“调查(询问)笔录上述内容,记录属实。”                                               

被调查(询问)人签字:                                                                     

调查(询问)人签字:                                                      

记录人签字:                                                             

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