Records Access Officer
Name of Agency
Address of Agency
City, State, Zip

Dear Records Access Officer:
Under the provisions of the New York Freedom of Information Law, Article 6 of the Public Officers Law, I hereby request the following records:

(list them here)

If there are any copying fees, I will gladly reimburse, up to the limit of the law (25¢/page).

As you know, the Freedom of Information Law requires that a governmental body respond to a request within five business days of receipt of said request. Therefore, I look forward to hearing from you sometime next week.

If for any reason any portion of this request is denied, please inform me of the reasons for the denial, in writing, and provide the name and address of the person or body to whom an appeal should be directed, while furnishing all other portions of the requested documents within the legally mandated time.

(your signature)

cc: (list of other recipients, if any)