字[　　]　　號 __________人民檢察院： 　　你院于____年____月____日以

________[　]_____號補充偵查決定書退回的______________案，已經補充偵查完畢。

結果如下： 　　_________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________ 　　______________________________________________________________________

　　現將該案卷宗____卷____頁及補充查證材料______頁附后，請審查。

(公安局印)

　　年　　月　　日

　　本報告書一式兩份，一份交檢察院，一份附卷。