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    浜屾墜杞︿拱鍗栧悎鍚屾�庝箞鍐欙紝鏈夊摢浜涘唴瀹�
  
  浜屾墜杞︿拱鍗栧悎鍚岃寖鏈�
  
  杞� 涓伙細____________________________ 涔版柟(鎵夸拱浜�)___________________________
  
  杞� 涓� 鍦� 鍧�锛� 涔� 鏂� 鍦� 鍧�锛歘___________________________
  
  杞� 涓� 鐢� 璇濓細 涔� 鏂� 鐢� 璇濓細
  
  杞︿富鏍规嵁銆婃棫鏈哄姩杞﹁締浜ゆ槗绠＄悊瑙勫畾銆嬶紝涓庝拱鏂瑰氨涓嬪垪杞﹁締鐨勪氦鏄撹揪鎴愬�備笅鍗忚��锛�
  
  涓�銆佽溅杈嗘儏鍐�
  
  杞︾被鍨嬪彿锛歘__________________________ 杞� 韬� 棰� 鑹诧細_________________________________________
  
  杞︾墝鍙风爜锛歘__________________________ 琛� 椹� 鍏� 閲岋細_________________________________________鍙戝姩鏈哄彿锛歘__________________________ 鐕� 鏂欙細_________________________________________杞︽灦鍙风爜锛歘___________________________ 鍒濇�″叆鎴锋椂闂达細_________________________________________
  
  浜屻�佽溅杈嗗叿澶囦笅鍒楄瘉浠跺強澶囦欢(鍦ㄦ柟鏍奸噷鎵撯�溾垰鈥濅负绀�)
  
  鈻¤�岄┒璇佹�ｃ�佸壇鏈� 鈻¤喘缃�绋�(璐�)璇� 鈻¤矾璐规敹鎹� 鈻¤溅鑸逛娇鐢ㄧ◣鏍囧織(鍙戠エ)
  
  鈻℃満鍔ㄨ溅杈嗙櫥璁拌瘉涔� 鈻″畾缂栬瘉(浣跨敤璇�) 鈻¤惀杩愯瘉 鈻″�囪儙 鈻″崈鏂ら《 鈻￠挜鍖�
  
  涓夈�佺‘璁ゆ墍璐�杞﹁締鐨勭洰鍓嶅疄闄呯姸鍐碉紝涓嶅緱浠ヨ溅鍐典负鐢变腑閫旈��杞︺��
  
  鍥涖�佽溅涓讳繚璇佽�ヨ溅鐨勬潵婧愬悎娉曪紝鎵嬬画榻愬叏銆佺湡瀹炴湁鏁堬紝骞舵壙鎷呭洜璇ヨ溅鍜屾墜缁�涓嶅悎娉曞紩璧风殑娉曞緥璐ｄ换銆�
  
  浜斻�佹垚浜や环浜烘皯甯�(澶у啓)____________________________鍏冩暣(锟�_____________________________________鍏�)
  
  鍏�銆佷粯娆炬柟寮�(鍦ㄦ柟鏍煎唴鈥溾垰鈥濅负绀猴細)
  
  1銆佹湰鍗忚��绛捐�㈠悗锛屼拱鏂逛竴鎬т粯娓呭叏杞︽��;鍔炵悊杞︽墜缁�銆�
  
  2銆佹湰鍗忚��绛捐�㈠悗锛屼拱鏂逛粯璐�杞﹀畾閲戜汉姘戝竵(澶у啓)________________(锟�_______鍏�)鍦�(锟�________澶╁唴锛�
  
  涔版柟浠樻竻浣欐�句汉姘戝竵(澶у啓) ______________________鍏冩暣(锟�___________鍏�)鍚庡姙鐞嗘彁杞︽墜缁�銆�
  
  涓冦�佸姙鐞嗚繃鎴凤細涔版柟搴斾富鍔ㄧН鏋佹寜鍗栨柟鐨勮�佹眰澶囬綈杩囨埛鎵�闇�璧勬枡锛岀敱鍗栨柟鍗忓姪鍔炵悊杩囨埛鎵嬬画鍔烇紝鍙栧緱杩囨埛鍙楃悊;鍥炴墽鎴栬�岄┒璇�(鍙栬瘉鏃堕棿浠ヨ溅绠℃墍鍙楃悊鍥炴墽鎵�瑙勫畾鐨勬椂闂翠负鍑嗭紝鍖呮嫭椤哄欢鏃堕棿)
  
  鍏�銆佽繚绾﹁矗浠伙細
  
  1銆佸崠鏂瑰湪鏀跺埌涔版柟璐�杞︽�鹃」鍚庯紝灏嗙Н鏋佸崗鍔╀拱鏂瑰姙鐞嗚繃鎴锋墜缁�锛屽�傛湭鑳藉皢杞﹁締杩囨埛鎵嬬画鍔炲Ε(杞︾�￠儴闂ㄩ��
  
  鎴愮殑寤惰��闄ゅ�栵紝灞婃椂鍙屾柟鍗忚皟瑙ｅ喅)锛屼拱鏂规湁鏉冩彁鍑洪��杞︼紝浣嗗簲缁存寔璇ヨ溅浜や粯鏃剁殑鐘舵�侊紝鍗栨柟灏嗗凡浠樼殑璐�杞︽�惧�傛暟閫�杩樼粰涔版柟銆�
  
  2銆佷拱鏂瑰簲鍦ㄦ彁杞﹀悗____鏃ュ唴鍗栨柟閰嶅悎鍔炵悊杩囨埛鎵嬬画锛屽�傞�炬湡鏈�鍔炵悊锛屽簲鍚戝崠鏂规敮浠樿繚绾﹂噾_____________鍏冦��
  
  3銆佸�備拱鏂归�炬湡鏈�浜ゆ竻浣欐�撅紝鍗栨柟鏈夋潈灏嗚�ヨ溅鍙︿綔澶勭悊涓嶉』閫氱煡涔版柟锛屾墍鏀跺畾閲戜笉鍐嶉��杩樸��
  
  涔濄�佽�ヨ溅鍦�20 骞� 鏈� 鏃� 鏃� 鍒嗕互鍓嶅彂鐢熶竴鍒囦氦閫氫簨鏁呫�佺粡娴庣籂绾枫�佹硶寰嬭矗浠诲潎鐢卞師杞︿富鎴栬浆璁╀汉璐熻矗锛岃�ヨ溅鍦�20 骞� 鏈� 鏃� 鏃� 鍒嗕互鍚庡彂鐢熶竴鍒囦氦閫氫簨鏁呫�佺粡娴庣籂绾枫�佹硶寰嬭矗浠诲潎鐢辨壙涔颁汉璐熻矗銆�
  
  鍗併�佽ˉ鍏呮潯娆撅細___________________________________________________________________________________
  
  ____________________________________________________________________________________________
  
  鍗佷竴銆佸綋璇ヨ溅浠庤溅鏂瑰悕涓嬭繃鎴峰埌涔版柟鍚嶄笅锛屼拱鍗栧弻鏂瑰姙鐞嗗畬绉讳氦鎵嬬画鍚庯紝鏈�鍗忚��鍗虫墽琛屽畬姣曘��
  
  鍗佷簩銆佹湰鍗忚��鍦板紡璐颁唤锛屼拱鏂逛竴浠斤紝鍗栨柟涓�浠斤紝浜ゆ槗鍚庝唬琛ㄧ�惧瓧鐩栫珷鍚庣敓鏁堛��
  
  澶囨敞锛氬�傞渶娉ㄦ槑杞﹁締钀ヨ繍鎴栭潪钀ユ�ц川鍜岃溅杈嗘煇涓�绯荤粺鎴栨煇涓�閮ㄤ欢鐨勮川閲忔儏鍐碉紝璇峰湪鏉℃�句腑琛ュ厖璇存槑銆�
  
  涔版柟锛� (绛剧珷)
  
  鍗栨柟锛� (绛剧珷)
  
  骞� 鏈� 鏃� 骞� 鏈� 鏃�
  
  浜屾墜杞︿拱鍗栧悎鍚屾�庝箞鍐欐枃绔犱腑宸茶�︾粏缁欏嚭锛屽湪鑼冩湰涓�瑕佹敞鎰忓啓娓呮�氳溅杈嗘儏鍐点�佽溅涓绘儏鍐点�佽溅杈嗙殑璇佷欢銆佹垚浜や环鏍笺�佸姙鐞嗚繃鎴峰拰杩濈害璐ｄ换绛夛紝鍦ㄨˉ鍏呮潯娆句腑涔熻�佹敞鏄庡彂鐢熺籂绾锋椂鐨勮В鍐冲姙娉曪紝鐜板湪浜屾墜杞﹀競鍦洪奔榫欐贩鏉傦紝鍦ㄧ�捐�㈠悎鍚屾椂瑕佷粩缁嗙殑鐪嬪ソ鍚堝悓涓�鐨勫唴瀹逛互鍏嶄笂褰撳彈楠楄�╄嚜宸遍�犳垚涓嶅繀瑕佺殑鎹熷け