FREEDOM OF INFORMATION ACT REQUEST FORM
Requester's Name: Date Requested:
Request Submitted By: E-mail U.S. Mail Fax In Person
Preferred method of delivery: E-mail Fax Other (Specify)
Request Received by: _
Requester is representing:
Address:
Telephone Number: Cell Phone Number:
Fax Number: Email Address:
Records Requested: Provide as much specific detail as possible so the public body can identify
the information that you are seeking. For example, include
address and PIN number of
property, if applicable. You may attach additional pages, if necessary.
Do you want copies of the documents? YES ___ NO___
o
Do you want Electronic Copies or Paper Copies? ____________________
o
If you want Electronic Copies, in what format? _____________________
Is this request for a Commercial Purpose? YES ___ NO ___
(It is a violation of the Freedom of Information Act for a person to knowingly obtain a public
record for a commercial purpose without disclosing that it is for a commercial purpose, if
requested to do so by the public body. 5 ILCS 140.3.1(c)).
Are you requesting a fee waiver? YES ___ NO ___
(If you are requesting that the public body waive any fees for copying the documents, you must
attach a statement of the purpose of the request, and whether the principal purpose of the request
is to access or disseminate information regarding the health, safety and welfare or legal rights of
the general public. 5 ILCS 140/6(c)).
This public body shall comply with or deny a request within five working days. Response time
can be extended an additional five working days, as allowed under the law.
Signature of Requester
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signature
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