检查笔录
时间_______年_______月_______日_______时_______分_______年_______月_______日_______时_______分
地点_______________________________________________________________
复查员姓名、单位___________________________________________________
侦查人员姓名、单位_________________________________________________
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检察人员姓名、单位_________________________________________________
被检查人诉讼身份、姓名、性别、年龄、住址
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见证人姓名、住址、单位_____________________________________________
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检查目的___________________________________________________________
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检查过程及结果_____________________________________________________
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