提請(qǐng)假釋建議書(shū)
（ ）字第 號(hào)
罪犯______，男 （女），______年______月______日生，______族，原戶(hù)籍所在地______，因____________罪經(jīng)____________人民法院于______年___________月______日以（ ）____字第______號(hào)刑事判決書(shū)判處________________，附加__________________，刑期自____________年______月______日至______年______月______日止，于______年_____月______日送我獄服刑改造。服刑期間執(zhí)行刑期變動(dòng)情況：________________________________________
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該犯在近期確有_______________表現(xiàn)，具體事實(shí)如下：
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為此，根據(jù)《中華人民共和國(guó)監(jiān)獄法》第______條、《中華人民共和國(guó)刑法》第_____條____款、《中華人民共和國(guó)刑事訴訟法》第_______條_____款的規(guī)定，建議對(duì)罪犯_______予以假釋。特提請(qǐng)裁定。
此致
________________________________人民法院
（公章）
________年___月____日
附：罪犯______卷宗材料共____卷______冊(cè)______頁(yè)。
