时间：_______年_______月_______日 _______分至_______年_______月_______日_______分地点：___________________________________________________________
侦查人员姓名、住址、单位：_______________________________________
辨认人员姓名、住址、单位：_______________________________________
见证人员姓名、住址、单位：_______________________________________
辨认对象：_______________________________________________________
辨认目的：_______________________________________________________
辨认过程及结果：_________________________________________________
侦查员：______________
辨认人：______________
见证人：______________
记录人：______________
签字：
