http://www.jbhfile.com/resourc…..foipa.html
<Name>
<AddressLine1>
<AddressLine2>
<insert DATE>
Re: Freedom of Information-Privacy Act request (FOIPA)
I, <insert name>, am requesting all documents the Federal Bureau of Investigation (FBI) has or maintains regarding myself as a person of interest in either current/open or past/closed investigations. In your search, please include all indices available to and part of the FBI records network.
Full Name:
XXXXXX
Current Address: XXXXXXXXXX
XXXXXXXXXX
Date of Birth:
XXXXXX
Place of Birth:
XXXXXXXX
Daytime Phone:
XXXXXXXX
It is my understanding that under FOIPA, there exist nine statutory exemptions which allow the FBI, on a discretionary basis, to withhold the provision of all (or segregable portions) of the requested documents; if above requested records or portions thereof are withheld due to the implementation of any constitutional exemptions stated in 5 U.S.C. § 552(b)(1)-(9), please note in writing that this is the case. Furthermore, please provide those records, or portions thereof, which are not within the statutory domain of any of the nine exemptions (5 U.S.C. § 552(b)).
It is my expectation that this request will be afforded due process via the FOIPA request system, including the assigning of an official FOIA request number. I am willing to incur all printing costs related to provision of requested documents.
Under penalty of perjury, I hereby declare that I am the person named above and I understand that any falsification of this statement is punishable under the provisions of Title 18, United States Code (U.S.C), Section 1001 by a fine of not more than $10,000 or by imprisonment of not more than five years, or both; and that requesting or obtaining any record(s) under false pretenses is punishable under the provisions of Title 5, U.S.C., Section 552a(i)(3) as a misdemeanor and by a fine of not more than $5,000. All signatures under the certification of perjury statement must be an original signature, as the FBI is no longer accepting faxed signatures.
Signature _______________________________________ Date_________________________
Thanks in advance,
<insert NAME>