第 页共 页
案由：_________________________________________
当事人：_______________________________________
合议时间：_______________ 主持人：____________
地 点：_______________________________________
合议人员：_______________ 记录人：____________
承办人员汇报案情（事实、证据、依据、办案程序）：_____________________________________________________
讨论记录：
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
合议意见：
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
主持人签字：______________
合议人员签字：____________
记录人签字：______________
