FOIA 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 Public Access Counselor, you will need to submit a copy of your FOIA request. **

Name and Address of Public Body Receiving Request:____________________________________________________________________________________________________________________________________________

Date Requested: ________________________________________________________

Request Submitted By: _____E-mail _____U.S. Mail _____Fax _____In Person

Name of Requester: _____________________________________________________

Street Address: _________________________________________________________

City/State/CountyZip (required): ___________________________________________

Telephone(Optional): __________________ E-mail (Optional): ___________________

Fax(Optional): _________________________________________________________

Records Requested: *Provide as much specific detail as possibleso 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 without disclosing that it is for a commercial purpose, if requested to do so by the public body. 5ILCS140.31(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 principle purpose is to access or disseminate information regarding the health, safety, and welfare or legal rights of the general public. 5 ILCS140/6©).