1234, Main Street
Boston, MA 02123
<Recipient Address Goes Here>
<We/I> have stopped payment on check #<number> from <source of check> because <reason>. The check is dated <date> in the amount of <$amount>.
<Optional disposition.> If you have any questions you should <call/write> <person> at <address or phone number>.
encl: <List of enclosed items goes here>