时间：____年____月____日____时____分至____年____月____日____时____分

　　公安局侦查人员：____________

　　根据____年____月____日________公安局签发的____字[　]____号____，在_______的见证下，对_______________ 进行搜查。

　　搜查的简要情况：___________________________________________________________________________________

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侦查人员：________________

　　　　　　　　　　　　　　　　　　　　　 被搜查人或其家属：________

　　　　　　　　　　　　　　　　　　　　　 见证人：__________________

　　　　　　　　　　　　　　　　　　　　　 记录人：__________________