Sample Free List

Name and Address of Public Body Receiving Request :

Date Requested:

Request Submitted By :
SelectEmailU.S. MailFaxIn Person

Name of Requester:

Street Address:

City/State/Country Zip (required):

Telephone (Optional) :

Emial (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 NoNoYesDo you want Electronic Copies or Paper Copies?Paper CopiesElectronic CopiesIf you want Electronic Copies, in what format?

Is This request for a Commercial Purpose ? Yes or No
YesNo
( 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 commercial purpose, if requested to do so by the public body. 5 ILCS 140.3.1(c) ).