询问地点：_______________________________________________________

询问时间：_________年_________月_________日_________时_________分至_________时_________分

询问机关：_______________________________________________________

询 问 人：_______________________________________________________

记 录 人：_______________________________________________________

被询问人姓名：___________性别：___________年龄：___________民族：________________________

　　文化程度：_______________职业：___________工作单位：_____________________________________

　　住 址：_______________________________________________________

问：_____________________________________________________________

答：_____________________________________________________________

行政处罚案件询问笔录　行政处罚案件询问笔录