家庭寄养协议(2014年)_小包公合同模板

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家庭寄养协议(2014年)

352次浏览 0次下载共7页发布日期：2014-07-04发布主体：宁波市公安局适用于中介服务行业适用于身份关系协议

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<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.1//EN" "http://www.w3.org/TR/xhtml11/DTD/xhtml11.dtd"><html xmlns="http://www.w3.org/1999/xhtml"><head><meta http-equiv="Content-Type" content="application/xhtml+xml; charset=utf-8" /><title></title><style type="text/css">body{ font-family:'Times New Roman'; font-size:1em; } ul, ol{ margin-top: 0; margin-bottom: 0; } .Normal{page-break-inside:auto;page-break-after:auto;page-break-before:auto;margin-top:0.0pt;margin-bottom:0.0pt;margin-left:0.0pt;text-indent:0.0pt;border-top-style: none;border-left-style: none;border-right-style: none;border-bottom-style: none;font-size:12.0pt;font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Default-Paragraph-Font{font-family:'Times New Roman';mso-fareast-font-family:'Times New Roman';mso-bidi-font-family:'Times New Roman';} .Table-Normal{} .Table-Grid{} </style></head><body style="pagewidth:595.3pt;pageheight:841.9pt;"><div class="Section0"><div style="min-height:72pt" /> 发文名称 : 宁波市民政局、宁波市发展改革委、宁波市公安局等关于解决本市公民私自收养子女有关问题的通知         家庭寄养协议   　　甲方：社会福利机构 　　乙方（寄养人）：男方姓名______，出生____年__月，身份证号码____________________，户籍地址____________________，现住地址____________________，职业__________；女方姓名______，出生____年__月，身份证号码____________________，户籍地址____________________，现住地址____________________，职业__________；被寄养人：姓名______，性别______，出生____年__月，被寄养人于____年__月__日在被捡拾，并由寄养人抚养至今，由于不符合《中华人民共和国民法典》规定条件，不能办理收养登记手续，为保护被寄养人的合法权益，乙方（寄养人）和夫妇现要求继续寄养被寄养人，经甲乙双方协商，就寄养事宜签订协议如下： 　　一、乙方自愿要求寄养被寄养人。 　　二、乙方作为被寄养人的监护人，承担抚养和教育被寄养人的责任，保证不遗弃、不虐待被寄养人和抚育被寄养人健康成长。如寄养人有虐待遗弃被寄养人的行为，寄养人不得继续寄养被寄养人，构成犯罪的，应承担相应的刑事责任。 　　三、寄养人和被寄养人之间为寄养关系，而非法律上的收养关系。如被寄养人的生父母、亲属或其他监护人前来认领被寄养人或有符合收养条件的收养人愿意收养被寄养人的，寄养人必须保证将被寄养人送还。 　　本协议一式两份，甲乙双方各执一份。 　　甲方签字（盖章）：__________________　　　 乙方签字（盖章）：__________________ 　　____年__月__日 　附件1 捡拾弃婴（儿童）情况证明 　　编号 <table cellspacing="0" style="border-collapse: collapse; width: 100%; "><tr style="height: 16.0px"><td rowspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡拾人 情况 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓名 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">公民身份号码 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">工作单位 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">家 庭 住 址 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">弃婴情况 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓名 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">性别 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">出生日期 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="4" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td rowspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡拾 情况 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡拾时间 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡 拾 地 点 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="4" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡拾 经过 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="10" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">以上情况均属实，如有不实，由本人承担全部法律责任捡拾人：（签字并按指纹） </td></tr><tr style="height: 16.0px"><td rowspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">证明人 情况 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓名 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">公民身份号码 </td><td colspan="6" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">工作单位 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">家 庭 住 址 </td><td colspan="6" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td rowspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">证明人 情况 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓名 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">公民身份号码 </td><td colspan="6" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">工作单位 </td><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">家 庭 住 址 </td><td colspan="6" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="10" style="vertical-align:top;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">以上情况均属实，如有不实，由本人承担全部法律责任证明人：（签字并按指纹）证明人：（签字并按指纹） </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">村（居）民 委 员 会 意见 </td><td colspan="9" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">乡 镇 （街道）人 民政府（办事处） 意 见 </td><td colspan="9" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td></tr></table>          　　此表一式三份，公安部门、人口计生部门、民政部门各留存一份。   　　附件2 捡拾弃婴（儿童）报案证明 　　编号 　　民政局： 　　依据《关于解决国内公民私自收养子女有关问题的通知》（民发〔2008〕132号）的规定，兹证明（报案人______，公民身份证号码____________________）于____年__月__日来本所报案称：______（被捡拾人） 于____年__月__日在____________________（地点）被（捡拾人______，公民身份证号码____________________ ）捡拾，未查找到其生父母。 　　特此证明。 　　县（市）区公安局 （分局）派出所（公章） 　　____年__月__日 　　联系电话： 　　附件3 收养人身体健康检查证明 <table cellspacing="0" style="border-collapse: collapse; width: 100%; "><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓名 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">性别 </td><td colspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">身份证 号码 </td><td colspan="7" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">民族 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">住址 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">联系电话 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="10" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">收养人体检结果：1、传染病情况：2、有关精神病：3、其他健康状况： </td></tr><tr style="height: 16.0px"><td colspan="10" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">医学意见（健康状况是否符合收养人身体条件）： </td></tr><tr style="height: 16.0px"><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">检查医师签字 </td><td colspan="4" rowspan="1" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">检查单位盖专用章 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:outset;border-bottom-color:#000000;border-bottom-width:1.0px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td colspan="3" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">科主任签字 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr></table>          　　备注：体检单位为县级及以上医疗机构。 　　附件4 收养人子女情况证明 　　（一）收养人无子女情况证明 　　______，男，____年__月__日出生，初（再）婚 　　身份证号码：____________________，住址：____________________。 　　______，女，____年__月__日出生，初（再）婚 　　身份证号码：____________________，住址：____________________。 　　两人于____年__月__日结婚，婚后一直未生育亦未收养子女。 　　备注： 　　（一方或双方系再婚者，须在备注栏写明每次结婚时间、离婚时间且未生育亦未收养子女） 　　特此证明 　　乡镇（街道）人民政府（办事处）计生办（公章） 　　____年__月__日 　　（二）收养人生育子女情况证明 　　______，男，____年__月__日出生，初（再）婚 　　身份证号码：____________________，住址：____________________。 　　______，女，____年__月__日出生，初（再）婚 　　身份证号码：____________________，住址：____________________。 　　两人于____年__月__日结婚（系初、再婚），婚后生育子女情况如下： 　　姓名：______（男、女），____年__月__日出生。 　　备注： 　　（属再婚者须在备注栏写明再婚前的婚姻、子女情况，包括原婚姻的对方姓名、结婚时间、何时生育子女及子女姓名、归属等情况） 　　特此证明 　　乡镇（街道）人民政府（办事处）计生办（公章） 　　____年__月__日 　　附件5 公民家庭寄养申请审核表 编号 <table cellspacing="0" style="border-collapse: collapse; width: 100%; "><tr style="height: 16.0px"><td rowspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">寄养人 情况 </td><td rowspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓 名 </td><td rowspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">性别 </td><td rowspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">出 生 年 月 </td><td rowspan="5" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">身份证号码 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td rowspan="4" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">家 庭 住 址 </td><td rowspan="4" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">工 作 单 位 </td><td rowspan="4" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">结 婚 时 间 </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">子 女 姓 名 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">性别 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">出生 年月 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td rowspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">被寄养 人情况 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">姓 名 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">性别 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">出生 年月 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡 拾 地 点 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">捡拾 时间 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td><td colspan="2" style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">  </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">村（居） 民委员会 印章 </td><td colspan="4" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">乡镇（街道）计生办印章 </td><td colspan="3" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">乡镇（街道）人民政府（办事处） 印章 </td><td colspan="4" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">县（市）区人口计生局印章 </td><td colspan="3" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td></tr><tr style="height: 16.0px"><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">县（市）区民政局印章 </td><td colspan="4" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td><td style="vertical-align:middle;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">县（市）区公安局 印章 </td><td colspan="3" style="vertical-align:bottom;border-top-style:solid;border-top-color:#000000;border-top-width:1.33px;border-left-style:solid;border-left-color:#000000;border-left-width:1.33px;border-right-style:solid;border-right-color:#000000;border-right-width:1.33px;border-bottom-style:solid;border-bottom-color:#000000;border-bottom-width:1.33px;padding-left:0pt;padding-right:0pt;padding-top:0pt;padding-bottom:0pt;">年月日 </td></tr></table>    　　此表一式三份，公安部门、计生部门、民政部门各存一份。 </div></body></html>