行政起诉状（范本）

原告：姓名、性别、出生年月日、民族、住址、电话、邮编

 

被告：名称、地址、法定代表人

 

诉讼请求：

 

1_________________________________________________________________________________________________

 

2_________________________________________________________________________________________________

 

事实与理由：

 

______________________________________________________________________________________________

 

______________________________________________________________________________________________

 

证据和证据来源，证人姓名和住址：

 

______________________________________________________________________________________________

 

______________________________________________________________________________________________

 

此致

 

________ 人民法院

 

                                                                                             起诉人：________

 

                                                                                               ____ 年____ 月____ 日

 

附：本诉状副本____ 份