Dear …

RE: __(Type of)__ License Reference: __(#/Name)__

I am writing to you with respect to the above mentioned __(type of )__ license. On __(date)__, I was made aware that __(name of organization)__ __(will be terminating/has terminated)__ this license on the grounds of __(briefly describe reason – i.e. failure to ….)__.

This letter is to inform you that the licensing requirements were, in fact, fulfilled. Per the attached __( type of documents)__, you will note that I __(briefly describe the requirements you fulfilled, which these documents are attesting to)__. Regrettably, I was not able to __(briefly describe what you were required to do)__ before the deadline of __(date)__ because of __(briefly describe reason)__. This unexpected and unfortunate incident simply did not allow me to __(briefly describe what you were required to do)__.

As you can clearly see, the situation was out of my control and, therefore, I respectfully request that the decision to terminate of my license, be reversed. If your department chooses not to overturn the decision to terminate my license, I ask that you kindly provide me with the date and location where I may present my case for appeal.

I thank you for your attention to this matter and look forward to hearing from you soon.

Yours truly,