This Freedom of Information Act request can be customized for requests of records by any individual, member of the media, or academic pursuits.
123 Main St.
Anytown, CA 95928
[Head of Agency]
[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.