Name
Title
Agency
Address
City, State, Zip Code

Dear __________________:

I am writing to request records under the (State) Open Records Law, Sec XXXX (State) Statutes.

Specifically, I request a copy of the (police/medical examiner/crime lab) report on the (type of death) of (victim name/suspect name) that occurred on mm/dd/yyyy.

I am with the State Health Department. This information will be entered in our existing database of violent deaths (homicide, suicide, unintentional firearm deaths and deaths of undetermined intent) for (state/location). Personal identifiers are maintained confidentially.

I understand there may be a fee for each page of the report copied. Please advise me on the most efficient way to submit this payment. I appreciate your assistance with this request. If you have any questions, I can be reached at (phone number). Should any portion of this request be denied, I request that such denial be made in writing in accordance with Sec. XXXX, (State) Statutes.

Cordially,