证据保全申请书

申请人:_____________

    申请人与__________因___________________一案，已于____年___月___日向你院提起诉讼。现因该案证据即将灭失（或者是以后难以取得），为此，特申请给予保全证据。

    事实和理由：
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    请求目的
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    此致
_________________人民法院

                                                      申请人：

                                                               年  月  日