附带民事诉讼诉状 原告人：__________________________ 地址：__________________________ 法定代表人（如法人）：________________ 委托代理人：______________________ 电话：__________________________ 邮编：__________________________ 被告人：__________________________ 地址：__________________________ 法定代表人（如法人）：________________ 诉讼请求：
1. 请求法院依法追究被告人的刑事责任； 2. 请求法院判决被告人赔偿原告人因犯罪行为造成的经济损失共计人民币____元，包括医疗费、丧葬费、死亡赔偿金、抚养费、精神损害抚慰金等； 3. 请求法院判决被告人承担本案的全部诉讼费用。
事实与理由：
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