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行政复议口头申请记录

时间:2022-06-29 15:56:02 浏览次数:

时间:________年_____月_____日_____时至_____时
地点:                                                           
记录人:                                                         
申请人:姓名                  性别      出生年月                 
职业                            职务                             
通讯地址                                    电话                  
住址                              身份证号码                     
代理人:姓名                   性别        联系电话               
职业                             地址                            
复议请求:                                                        
                                                                 
                                                                 
                                                                 
事实和理由:                                                     
                                                                 
                                                                 
                                                                 
                                                                 
                                                                 
 
申请人:                代理人:              记录人:  

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