答辩人姓名_____________性别____出生年月日________民族____出生地_____________________
                  文化程度______职业__________职务___________住址_____________________________________
                  答辩人因______________________________________________________________________一案，
                  提出答辩如下：
                  ____________________________________________________________________________________

                  此致
                  _________人民法院

                  附：本答辩状副本__份
                  答辨人_________
                  _____年__月__日