Date
Joint
Personnel Recovery Agency
ATTN: FOIA Requestor Service Center
10244 Burbeck Road - Building 358
Fort Belvoir, VA 22060-5805
Dear
FOIA/Privacy Act Coordinator:
Under
the Freedom of Information Act/Privacy Act, I am requesting
records on (Provide individual's full name and date and place
of birth. Provide any aliases they may have used.) Describe
the type of record(s) being requested. Give the approximate
time frame for each specific event. And state your reason
for requesting the record(s).
If
you deny all or any part of this request, please cite each
specific exemption you think justifies your refusal to release
the information and notify me of appeal procedures available
under the law.
If
you have any questions about handling this request, you may
telephone me at (home phone) or at my (office phone).
Sincerely,
(Requestor's Original Signature Is Required.)
Name
Address
(Original
Notarized Signature Of Individual Who Records Pertain To Is
Required.)
Name
Address
**If
you are unable to visit a notary, you may instead have the
individual who the records pertain to attest to the truth
and correctness of the authorization by adding the following
statement to the consent form:
"I
certify under penalty of perjury under the laws of the USA,
that the foregoing is true and correct."
(Original
Signature Of Individual Who Records Pertain To Is Required.)
Name
Address
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