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行政处罚决定执行笔录

案由                                案件编号                        

被处罚单位（个人）                                                  

执行项目                                                           

执行时间             年     月     日至            年     月     日

执行地点                                                            

执行人                             执法证号                         

记录人                             执法证号                         

违法建设处理决定内容：                                             

执行情况：                                                         

                               执行人签字：           年    月    日