This Freedom of Information Act request can be customized for requests of records by any individual, member of the media, or academic pursuits.
Andy Anderson 123 Main St. Anytown, CA 95928 (555) 555-1212 email@example.com
[Head of Agency] [Agency] [Address] [City, State, ZIP]
Re: Freedom of Information Act Request
August 14, 2010
This request is being made under the Freedom of Information Act.
I hereby request that a copy of the documents [described below/containing the information described below] be provided to me:
In regard to the assessment of fees, I would like to let you know that this request is being made for noncommercial or scholarly uses and I am a [representative of the news media/affiliated with an educational institution/________]. Therefore, I request a waiver of all fees as providing this information is in the public interest as explained below:
[alternative text]: I am willing to pay fees of up to $______ for this request. If you expect fees to be assessed and exceed this amount, please let me know before filling the request.