时间____年____月____日____时____分至____年____月____日____时____分
地点_____________________________________________________________
侦查人员姓名、单位_______________________________________________
辨认人姓名、 住址、 单位_______________________________________
见证人姓名、住址、单位___________________________________________
辨认对象_________________________________________________________
辨认目的_________________________________________________________
辨认过程及结果___________________________________________________
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侦查员：_______________
辨认人：_______________
见证人：_______________
记录人：_______________
