不服民事裁定申请复议书
申请人：姓名______________性别__________
出生年月日__________民族_________籍贯_______________
工作单位和职务________________住址_______________________电话_______________________
申请人因不服____________
人民法院______年______月______日( )字第______号，特申请复议，理由如下：
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
此致
____________人
民法院
申请人：_____________
_____年_____月_____日
