Fillable Foia Request VILLAGE OF LINCOLNSHIRE

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Foia Request VILLAGE OF LINCOLNSHIRE

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The Foia Request VILLAGE OF LINCOLNSHIRE form is 2 pages long and contains:

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  • 15 check-boxes
  • 25 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Village of Lincolnshire

BROWSE VILLAGE OF LINCOLNSHIRE (IL) FORMS

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1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-883-8600
F: 847-883-8608
Page 1 of 2
STAM
P HERE
FREEDOM OF INFORMATION ACT (FOIA) REQUEST FORM
REQUEST FOR RECORDS
Describe in detail the public records or information that you wish to inspect or to have copied or certified
below, use a separate sheet if necessary. Indicate the method for receipt of the public
Record(s)/information you are requesting by checking the appropriate box (below) to the right of each
record/information described.
I hereby request the right to inspect, or to obtain copies or certified copies of, the following public
records/information of the Village:
RECORDS REQUESTED
Inspect
Certify
PURPOSE OF REQUEST
Noncommercial Purpose
*A “commercial purpose” is defined under the Act as the use of any
part of a public
record or records, or information derived from public
records, in any form for sale,
resale, or solicitation or advertisement
for sales or services. Please be advised
that misrepresentation of the
purpose of a Request is a violation of the Act.
Commercial Purpose *
IDENTIFICATION OF REQUESTOR (Complete information must be provided)
Name of Requestor: ___________________________________________________________________
Name for whom records are being requested (if different from above): ___________________________
Address: ______________________________________________
Suite # _____________________
City: _____________________________________
State: _____
Zip Code: ___________________
Phone: __________________________________
Email:___________________________________
SIGNATURE OF REQESTOR
By signing this Request, I acknowledge and represent that I have reviewed and understood the Village’s
FOIA Policy and that all of the information provided in support of this request is true and accurate.
Name of Requestor (please print): _______________________________________________________
Signature of Requestor: ___________________________________
Date: _____________________
Email:
The Village will disclose the public records requested on this form within five working days after the
receipt of this form (or 21 days for a Commercial Purpose Request), unless the time period is extended
as provided by law or the request is denied. All extensions and denials will be in writing and will state the
reasons therefore. A denial may be appealed to the Public Access Counselor within 60 working days after
the date of the Notice of Denial. Judicial review is available under Section 11 of the Illinois Freedom of
Information Act, 5 ILCS 140/1 et seq.
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Freedom of Information Act Request Form
1 Olde Half Day Road, Lincolnshire, IL 60069
www.lincolnshireil.gov
P: 847-883-8600
F: 847-883-8608
Page 2 of 2
AGREEMENT TO PAY FEES
By submitting this Request Form, you are agreeing to pay the fees set forth below to the Village in
advance of receiving copies of any public records/information and certification. Further, if the services of
an outside vendor are required to copy any public record(s), you acknowledge and agree to pay the
actual charges that the Village incurs in connection with such copying service(s).
Black/White copies (letter or legal size)
No charge for first 50 pages, $0.15 each additional page
Color copies
$0.25 per page
Large Format copies
$5.00 per sheet
Certification
$1.00 per document plus copy cost
Mailing
Actual cost of
postage
WAIVER OF FEES (if applicable)
The fees (above) may be waived or reduced by the FOIA Officer only upon proof that the purpose of your
request is primarily to benefit the general public and that you will receive no significant personal or
commercial benefit from your request.
I request a waiver of the fees set forth above, and, in support of such request, I certify and represent
that I will gain no significant personal or commercial benefit from the records requested and that my
principal purpose in making this request is to benefit the general public by disseminating information
concerning the health, safety, welfare, or legal rights of the general public:
Signature of Requestor: __________________________________
Date: _______________
OFFICE USE ONLY
Received Date: ______________
Time: _____________________
Response Due: ______________
Method of Delivery:
In Person Email Mail Courier Fax Other
Village Employee Receiving Request:
Name: ________________________________________________
Title:_______________________
Signature: _____________________________________________
Date Completed: _____________
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Foia Request VILLAGE OF LINCOLNSHIRE

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Completed 13 July 2020

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