公安行政赔偿申请

行政赔偿申请书  （适用于法人及其他组织）  赔偿请求人：
                                                          住所：
                                                                法定代表人（负责人）：
                                                身份证件名称：
               证件号码：
                       电话：
                      邮政编码：
                      赔偿义务人：        工商行政管理局
                        法定代表人：
                                                地址：
                                                       赔偿请求：
                                                    
                                                              
                                                              事实与理由：
                                                          
                                                            
                                                              
                                                            
                                                            综上所述，请求
                                        。
   申请人：
                     年    月   日