行政复议听证笔录

案由：      （写明相关的案件事由） 。
听证时间：  年  月  日  午 时  分至  午  时  分 地点：                                                          主持人：                                                         
听证员：                                                     
记录人：                                                          
申请人：                                                                      被申请人：                                                             第三人：                                                          
证人：                                                        审理记录：                                                                                                                     
                                                             
申请人：                       被申请人：           
（签字或盖章）                   （签字或盖章）
第三人：                        证   人：             
（签字或盖章）                   （签字或盖章）