FREEDOM OF INFORMATION ACT REQUEST

Note to Requester: Retain a copy of this request for your files. If you eventually need to file a Request for Review with the Freedom of Information Officer, you will need to submit a copy of your FOIA Request.

Name and address of public body receiving request: ________________________________________________________________

________________________________________________________________

Date requested: ___________________________________________________

Name of requester: ________________________________________________

Street address: ___________________________________________________

City/State/County/ZIP (Required): ______________________________________

Telephone (Optional): ___________________Email (Optional): _________________

Fax (Optional): _____________________________________________________

Records requested: (Provide as much specific detail as possible so the public body can identify the information that you are seeking. You may attach additional pages, if necessary.

Do you want copies of the documents? YES or NO

            Do you want electronic copies or paper copies? _____________________

            If you want electronic copies, in what format? _______________________

Is this request for a commercial purpose? YES or NO_____________________

            (It is a violation of the Freedom of Information Act for a person to knowingly obtain a public record 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 or 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))