Simply replace the unfilled areas such as "" and "[date]" with your information.
Seriously, you [swear word] lunatics, turn off the [source of irritation] on the [location] before I lose my head and throw myself off the [location of irritation]. You have taken the act of [instance where you experienced irritation], which is already the most torturous thing on earth, and made it somehow worse.
This is a real coup. Please demote whoever came up with this idea to a nice [low wage $]/hr job in the mail room, get rid of the [source of irritation], and help me keep the few goddamn shreds of sanity I have left.