John Doe
120 Main Street
Spiegal, New York 20123
{date}
Re: Freedom of Information Act / Privacy Act Request for Personal Records
To Whom It May Concern:
This is a request for records and documents, both digital and physical, under the provisions of the Freedom of Information Act and the Privacy Act. Please process this request under both statutes to release the maximum number of records
and documents. I request copies of all files, correspondence, or other records concerning myself. To assist you with this search, I am providing the following information about myself:
Full name: John Doe
Other names and online aliases: Alioshka, citizenM, Politiwatch, milesmcc
My date of birth: January 31, 2001
My place of birth: New York City, NY
My social security number:
My phone number: (917) 767-3107
My email(s): [email protected]
This is an individual request for research and study purposes, and I agree that I will pay up to
$30 in fees, if necessary. Please notify me in advance if fees are expected to exceed that amount.
Please contact me at ___________ if you have any questions.
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.
Respectfully,
Miles McCain
