You must fill out and submit this form with each new action. The foregoing instrument was acknowledged before me this ______ day of 20____, by.City, State Zip Code. Dear. This is a request for public records made under OPRA and the common law right of access. I am not required to fill out an official form. Acknowledgement and Signature. Use an LGL letter template; Use a Microsoft Word letter template. For an acknowledgment in a representative capacity: STATE OF FLORIDA.