民事再审申请书

申请人:_____________

    申请人对_______________人民法院____年___月___日（____）_________字第______号（司法
文书）________________________不服，请求再审。

    申请事项：
    1、________________________________________________________________________________
_______________________________________________________________________________________
    2、________________________________________________________________________________
_______________________________________________________________________________________
    3、________________________________________________________________________________
_______________________________________________________________________________________

    事实与理由： 
    ___________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

    此致
_________________人民法院

                                                    申请人：

                                                               年  月  日
附：
    1、原终审判决书1份；
    2、证据和证据来源，证人姓名和住所。