案由：_______________________________________________________________________________________

　　审理时间：_______年_______月_______日_______午_______时_______分至_______午_______时_______分

　　讨论地点：___________________________________________________________________________________

　　主持人：_____________________________________________________________________________________

　　记录人：_____________________________________________________________________________________

　　出席人员：___________________________________________________________________________________

承办人汇报案情，讨论记录与决定：_____________________________________________________________

_____年_____月_____日