谈话时间： 年 月 日 时 分
谈话地点 ：_______________________________________
谈话人 ：___________ 工作单位：__________________
记录人 ：_________________________________________
被谈话人姓名 ：_________ 性别：_____ 年龄：_____
住址：____________________ 联系电话：_____________
谈话记录如下：________________________________________________
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