I'm sure someone will respond with one, but you can also use google to find a DMCA compliant complaint to fill in the blanks on. There are a lot of them out there.
Here's a complaint letter:
http://www.authorslawyer.com/c-pir-l2.html
An ISP Letter:
http://www.authorslawyer.com/c-pir-l3.html
Here's a response letter:
http://www-2.cs.cmu.edu/~dst/Terrorism/form-letter.html