Here are some templates of Reconsideration Requests that have been used to remove Google Penalties.
This is a successful Reconsideration Request that was used to get a manual penalty removed (Partial Match) revoked. The site was bought with the penalty and has now recovered very well. Dear Webspam Team, Site background example.com was purchased on August 15, 2014 from John Smith. During due diligence we requested all information about SEO [...]
This is a site that had thousands of spammy links and was penalised with a manual action in April 2012. The manual action was revoked in April 2014 using this template. Hi, mysite.com has a manual spam action: Unnatural links to your site—impacts links I believe the problem is that we have some poor backlinks [...]