申请人(本诉原告)：__________________
申请内容：________________________________________________________________________________________________________
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申请理由：________________________________________________________________________________________________________
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为保证诉讼顺利进行，维护国家利益，根据我国《中华人民共和国行政诉讼法》第三十六条之规定，特向你院申请保全证据。
此致
______人民法院
申请人：__________
____年____月____日