行政处罚案件有关事项审批表

案件名称：                                               

当事人姓名或单位名称：                                     

报请审批的事项：                                        

                                                                             提请审批的理由和依据：                                   

承办人：                

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                                                                             承办处（科、股）室意见：                                  

负责人：                

              年   月   日 

                                                                             审批意见：                                                

负责人:                 

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