Mail requests to:
City of St. Charles
Attn: FOIA Officer, Records Management Dept.
Two East Main Street, St. Charles, IL 60174
(630) 377-4400 Fax: (630) 377-4430
Freedom of Information Act Request
Please type or print
Name __________________________________________________
Organization (if applicable)______________________________________________________________
Address_____________________________________________________________________________
____________________________________________________________________________________
Daytime Telephone No. (_____) ____________________ Fax No. (_____) ________________________
E-mail Address________________________________________________________________________
Records requested (Please be as specific as possible. Include address, dates/timeframe, type of records,
etc. Attach additional pages if necessary):
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Is this information to be used for commercial purposes; i.e. used for sale, resale or solicitation
for sales or services? (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)) .
Signature of Requester___________________________________________ Date__________________
The City will respond to a request for public records within five (5) business days after receipt.
Date Received
Date Due____________________
Ext. Date Due_________________
City Use Only
5-Day Extension: Date Letter Sent _______________Denied Request: Date P.A.C. Notified_______________
P.A.C. Response____________________________________________________________________
__________________________________________________________________________________
Date Due to Records Management ___________
(Please be sure to include time spent working on this FOIA request)
Routed to:
Time Time Time Time
□ B&CE ________ □ City Admin ________ □ Community Dev. ________
□ Econ. Dev. ________ □ Electric ________ □ Finance ________
□ Fire ________ □ H.R. ________ □ Inventory Control ________
□ Police ________ □ P.W. ________ □ Purchasing ________ □ U.B. ________
Comments:
___________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Yes □ No □
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