元氏县人民法院 > 诉讼服务

申请人                 性别                   民族                        出生年月日                     

籍贯                  现住址                                                          联系电话                            

申请人对元氏县人民法院                   年                      月                    日作出的（                ）元民                   初字第      号判决书不服，申请对本案再审。

请求事项：                                                                                                                                                                                                                                               

事实与理由：                                                                                                                                                                                                                                                           

    此致

元氏县人民法院

附：原审判决书复印件一份

 申请人               

   年     月      日