1234, Main Street
Boston, MA 02123
04 April, 2005
<Recipient Address Goes Here>
Re: Request for Stop Payment
Account No. <number>
I am writing to request that you stop payment on a check written on the above-referenced account. I would like to stop payment on check number <check number>, which was issued on <date>, and made payable to <payee>. The check was issued in the amount of <amount>.
I would appreciate it if you would provide me with written confirmation that payment on this check has been stopped. Thank you for your assistance in this matter.
encl: <List of enclosed items goes here>