PLEASE SEND ME A COPY OF MY FBI FILE:
UNDER THE PRIVACY ACT & THE FREEDOM OF INFORMATION ACT
Federal Bureau of Investigation
Records Resources Division - Attn.: FOIA/PA Office
J. Edgar Hoover Building
9th & Pennsylvania Avenue NW
Washington, DC 20535
This is a request for records under both the Privacy Act and the Freedom
of Information Act., because I would like to get a copy of the records
about me at the FBI.
I request a copy of any and all records at the FBI that mention me,
as documents, reports, memoranda, letters, electronic files, 'See Also'
files, 'Do Not File' files, 'Official & Confidential' files, 'Personal
Confidential' files, photographs, audio tapes & videotapes, electronic
microphone surveillance (ELSUR or MISUR), or photographic surveillance,
'June mail', 'Obscene' Files, 'Subversive' Indexes, bulkies, mail
covers, trash covers; and any index citations relating to me or
referencing me ('see also') in other files. Please search all your
indexes, and interpret this request broadly. This should include
ELSUR search. I also request a copy of the 'FOIA Search Slip'
as a result of this request.
My full name is: ________________________________. My date of birth
My place of birth was: _______________________. Optional: I have
in places including:
Other names I've used; or places, events, publications, companies or
organizations for which you may find applicable records:
FOIA/PA statutes provide that even if some of the requested material
properly exempt from mandatory disclosure, all segregable portions
be released. If the requested material is released with deletions,
please mark each deletion to indicate the exemption(s) being claimed
authorize each particular withholding. In addition, I ask that
agency exercise its discretion to release records which may be
technically exempt, but where withholding serves no important public
I hereby agree to pay reasonable costs associated with this request
to a maximum of $30. Please notify me if the fees are expected
exceed this amount. I am aware that this request may take slightly
longer than the time limit of 10 working days provided by law.
NOTE: I WANT ALL FILES, NOT JUST MAIN FILES. DO IT RIGHT
TIME OR I WILL SIMPLY APPEAL THE RESULT.
NOTE: My signature below has been certified by a notary
Requester's printed name
Notary stamp and signature (required)