听证笔录

案件名称：                                                             

主持听证机关:                  地点:                                  

听证时间：     年  月   日   时   分至     年  月   日   时   分

主持人：               听证人：                书记员：               

调查人员：                     执法证号：                            

                     执法证号：                            

申请听证单位法定代表人姓名：           性别：     年龄：       

工作单位（职务）：                                                                  

委托代理人：      性别：      年龄：     工作单位（职务）：                                                                 

第三人：      性别：      年龄：     

工作单位（职务）：                                                                  

其他参与人员：      性别     年龄     

工作单位（职务）                                                                

听证记录：                                                                              

                                                                                      

                                                                                      

                                                                                     

                                                                                     

                                                                                           

                                                                                        

                                                                                      

当事人或其委托代理人签名及时间：                  

主持人签名:               

书记员签名:               

                                  

XXX县公路路政管理大队（印章）

                                  年   月   日