听证笔录（税务行政处罚）
共 页第 页
案 由：_________________________________________________________
时 间：_________________________地 点：________________________
听证主持人：_______________________记录员：________________________
当事人姓名：______________性别：___________年龄：__________________
工作单位：_________________________职务：__________________________
现住所：___________________________________________________________
调查人员姓名：_____________________________________________________
委托代理人姓名：___________________________________________________
工作单位：_________________________职务：__________________________
现住所：___________________________________________________________
听证记录：_________________________________________________________
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听证笔录续页
共 页第 页
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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听证主持人签字： 记录员签字：
当事人签字： 代理人签字：
本案调查人签字： 证人签字：
