[Your letterhead, if desired; if not, your return address]
[Date of letter-month, day, and year]
[Recipient's first and last names]
[Street or P.O. box address]
[City, State ZIP code]
Dear [recipient's name]:
I am writing to notify you that I am now appealing ______________________ [specifics on what you are appealing] as specified __________________________ [in recipient's correspondence, phone call, etc.]. This appeal is effective as of __________________________ [date on which your appeal takes effect, such as today's date or another date].
Please contact me by calling ____________________.[phone number] or emailing __________________ [email address] if you have questions or need further information. Thank you for your prompt attention to this matter.
[Sender's first and last names]