[Your Name] [Your Address] [City, State, ZIP Code] [Email Address] [Phone Number] [Date] Federal Bureau of Investigation Records/Information Dissemination Section 170 Marcel Drive Winchester, VA 22602-4843 Subject: Request for FBI Files — Freedom of Information Act (FOIA) Request Dear Sir/Madam, I am writing to formally request access to my FBI files, pursuant to the provisions of the Freedom of Information Act (FOIA), 5 U.S.C. § 552. I have reason to believe that documents relevant to my personal history may be contained within the records maintained by the FBI. Personal Information: Full Name: [Your Full Name] Date of Birth: [Your Date of Birth] Place of Birth: [City, State, Country] Social Security Number (last 4 digits): [Last 4 digits of SSN] Current Address: [Your Current Address] Former Addresses (if applicable): [List Former Addresses If Any] I hereby confirm my identity as the subject of this request. Please find enclosed a copy of a government-issued identification card (e.g., driver's license, passport) for verification purposes. Additionally, I have completed and signed the attached Privacy Act Statement (Form DOJ-361) and included it with this request. I respectfully request a comprehensive search of your records, including but not limited to: 1. Any investigative or incident reports filed by or pertaining to me. 2. Any surveillance records, intelligence reports, or other materials documenting my activities. 3. Correspondence, memos, or notes referring to or mentioning my name. 4. Any records associated with background checks, security clearances, or employment-related investigations. Please include all relevant and related information, irrespective of form or format, including paper documents, electronic records, audio or video recordings, photographs, or any other documents within the scope of this request. In the event that fees may be applicable for the processing of this request, I am willing to pay reasonable fees up to a specified amount. However, I would appreciate advance notification if the estimated fees might exceed this amount. If you determine that any portions of the requested records are exempt from disclosure, I request that you provide me with any segregate non-exempt portions that can be released. Moreover, please provide an itemized index of all documents withheld, the specific reason for each exemption, and a statement indicating whether discretionary release of any exempt information is possible. I request that all responsive records be provided in electronic format, preferably PDF or searchable text format, through the email address provided above. However, should electronic delivery pose any difficulty, please inform me and I will make suitable alternative arrangements. I kindly request your prompt attention and completion of this request, as required by law. If you believe that additional clarification or information is necessary to fulfill this request, please do not hesitate to contact me at the provided contact information. Thank you for your assistance in this matter. Sincerely, [Your Full Name] Enclosures: 1. Copy of Identification Document (e.g., driver's license, passport) 2. Privacy Act Statement (Form DOJ-361)
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.