民事反诉状
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<td class=art03 vAlign=top align=left><TABLE style="FONT-SIZE: 9pt; LINE-HEIGHT: 20pt" cellSpacing=0 cellPadding=0 width=550 align=center border=0>
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<TD><STRONG>反诉人（本诉被告）：</STRONG>__________________________________________<STRONG> </STRONG>（写明基本情况）</TD></TR>
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<TD><STRONG>被反诉人（本诉原告）：</STRONG>__________________________________________ （写明基本情况）</TD></TR>
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<TD><STRONG>反诉请求：</STRONG></TD></TR>
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<TD> __________________________________________________________________________________</TD></TR>
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<TD><STRONG>事实与理由：</STRONG></TD></TR>
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<TD> __________________________________________________________________________________<BR>（写明事情具体起因、经过、内容、及有关法律、政策依据等）</TD></TR>
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<TD><STRONG>证据和证据来源：</STRONG></TD></TR>
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<TD> __________________________________________________________________________________</TD></TR>
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<TD> </TD></TR>
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<TD> 此致 </TD></TR>
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<TD> ___________人民法院 </TD></TR>
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<TD> </TD></TR>
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<TD align=right>反诉人：________</TD></TR>
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<TD align=right>_____年___月___日</TD></TR>
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<TD align=right> </TD></TR>
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<TD>附：本反诉状副本______份。</TD></TR></TBODY></TABLE></td>
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