市公安局   分局

解除强制戒毒证明书

公（ ）解戒证字[  ]第  号

被强制戒毒人  _________ 性别 ______  出生日期_________________

现住址________________________________________________________

工作单位______________________________________________________

强制戒毒决定书文号____________________________________________

强制戒毒期限 _________________________________________________

强制戒毒地点__________________________________________________

承办人________________________________________________________

批准人________________________________________________________

填发人________________________________________________________

填发日期______________________________________________________