民事申诉状(公民提起申诉)

民事申诉状(公民提起申诉)

    申诉人:
    申诉人因__________一案,对__________人民法院______年______月______日(__________)__________字第__________号民事判决(或裁定),提出申诉。
    请求事项:________________________________________________________________________________________________________
    ______________________________________________________________________________________________________________________
    ______________________________________________________________________________________________________________________
    事实与理由:______________________________________________________________________________________________________
    ______________________________________________________________________________________________________________________
    ______________________________________________________________________________________________________________________
    此致
    ________人民法院
    申诉人:__________
    ____年____月____日
    附:
    1.原审民事判决书(或裁定书)________份;
    2.证据材料________份。