提請假釋建議書
( )字第 號
罪犯______,男 (女),______年______月______日生,______族,原戶籍所在地______,因____________罪經____________人民法院于______年___________月______日以( )____字第______號刑事判決書判處________________,附加__________________,刑期自____________年______月______日至______年______月______日止,于______年_____月______日送我獄服刑改造。服刑期間執行刑期變動情況:________________________________________
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該犯在近期確有_______________表現,具體事實如下:
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為此,根據《中華人民共和國監獄法》第______條、《中華人民共和國刑法》第_____條____款、《中華人民共和國刑事訴訟法》第_______條_____款的規定,建議對罪犯_______予以假釋。特提請裁定。
此致
________________________________人民法院
(公章)
________年___月____日
附:罪犯______卷宗材料共____卷______冊______頁。