第 页共 页
案由：_________________________________________________________
当事人：________________
讨论时间：______________ 地点：_______________________________
主持人：________________ 汇报人：_________ 记录人：__________
参加人：________________
主要违法事实（证据、依据、办案程序及处罚意见）：
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讨论记录：
_______________________________________________________________________________________________
_______________________________________________________________________________________________
___________________________________________________________________________________________
讨论决定：
_______________________________________________________________________________________________
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主持人签字：_______________
参加人员签字：_____________
记录人签字：_______________
