当事人陈述申辩内容

时间：_______年_______月______日______时______分至_______日______时______分

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陈述申辩人：________________性别：_______________职务：_____________________

工作单位：_______________________________________电话：_____________________

联系地址：_______________________________________邮编：_____________________

承办人：_________________________________________记录人：___________________

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陈述申辩人（签名）：___________

承办人（签名）：_______________

记录人（签名）：_______________

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