询问机关:_____________________________________________
询问地点:_____________________________________________
询问时间:____年____月_____日____时____分至____时____分
询问人 ________________________________________________
记录人_________________________________________________
被询问人姓名:______ 性别:____ 年龄:____ 职务:____
联系电话:______________ 工作单位 :_________________
住址:_________________________________________________
问:我们是 ___________执法人员,这是我们的执法证件,请你确认。
答:________________________________________________________
问:____________________________________________________________________________________________________________
答:____________________________________________________________________________________________________________
被询问人签名或盖章:_________
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2024-11-07287
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