行政处罚决定执行记录

案件名称及编号：                                                                          

当 事 人：                                                                                     

行政处罚内容：                                                                              

                                                                                                    

                                                                                                    

                                                                                                     

                                                                                                    

                                                                                                     

                                                                                                    

                                                                                                    

                                                                                                     

执行记录：                                                                                   

                                                                                                     

                                                                                                    

                                                                                                    

                                                                                                     

                                                                                                    

                                                                                                    

                                                                                                    

                                                                                                    

                      记录入(签名)：                                            

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