第_____页 共____页 (此处印制公安机关名称) 听 证 笔 录 案由____________________________________________________________ 时间______年____月___日____时____分至_____年____月____日_____时____分 地点________________________举行方式____________________________ 听证主持人______________________________________________________ 听证员__________________________________________________________ 记录员__________________________________________________________ 违法嫌疑人______________________________________________________ ________________________________________________________________ 法定代表人______________________________________________________ 委托代理人______________________________________________________ 本案其他利害关系人______________________________________________ ________________________________________________________________ 本案其他利害关系人的代理人______________________________________ 本案办案人民警察________________________________________________ 听证内容记录____________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ (可附页) 第_______页 ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ 违法嫌疑人或者代理人(签名):__________________________________ 其他利害关系人或者代理人(签名):______________________________ 证人(签名):____________________________________________________ 听证员(签名):________________________________________________ 听证主持人(签名):____________________________________________ 记录员(签名):__________ 年 月 日