Records Request Form - Adams County Sheriff'S Office
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1Adams County Sheriff’s Office
Courthouse · 521Vermont Street · Quincy, IL 62301
Phone 217-277-2200
Fax
217-277-2214
Brent Fischer, Sheriff
Date of Request: ___________________
Name of Requester: _______________________________________________________________
* Note to Requester: Retain a copy of this request for your files. If you need to file a Request for Review with the Public Access Counselor, you will need to
submit a copy of your FOIA request.
Street Address: ___________________________________________________________________
City/State/Zip (required): ___________________________________________________________
Telephone: ___________________ Email (Optional): ___________________________________
Records Requested:
Provide as much specific detail as possible so the public body can identify the information that you are
seeking including the case number, if known. You may attach additional pages, if necessary.
________________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________
_______________________________________________________________________________________________
Do you want copies of the documents requested? ________YES ________ NO
Do you want electronic copies or paper copies? ____________________________
If you want electronic, indicate in what format. ____________________________
Is this request for a Commercial Purpose? ________ YES ________ 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. 5 ILCS140.3.1(c)
Are you requesting a fee waiver? ________ YES ________ 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)
Administrative Use Only:
Request Submitted By: _______ Email _______ U.S. Mail _______ Fax _______ In Person
Date Request Received by Office: __________________ Date Request Due: ________________
Request Approved: ______YES ______NO
Date Requested Completed: __________________
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