（公民提起民事、行政诉讼用）

原告___________________________________________________________________________

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被告___________________________________________________________________________

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                           诉讼请求

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                           事实与理由

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                   证据和证据来源，证人姓名和住址

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     此致

           人民法院

  附：本诉讼副本   份

                                                       起诉人

                                                    年   月    日

注：1.本诉状供公民提起民事、行政诉讼用，用钢笔或毛笔书写。

     2.原告、被告栏，均应写明姓名、性别、出生年月日（对民事被告的出生年月日确实不知的，可写其年龄）、民族、籍贯、职业或工作单位和职务、住址等。被告是法人、组织或行政机关的，应写明其名称和所在地址。

     3.实是与理由得空格不够用时，可增加中页。

     4.起诉状副本份数应按被告的人数提交。

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