This letter claims that you are exempt from paying income tax for the previous year.
1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
I assert that I am exempt from paying federal income tax for <year>, because <reason>.
If there is some error in this statement of exemption, please notify me of it immediately. Thank you.
encl: <List of enclosed items goes here>