Freedom Of Information Act Request - City Of West Chicago
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1City of West Chicago
Attn: Valeria Lopez, FOIA Officer
475 Main Street
West Chicago, IL 60185
(630) 293-2200
Fax: (630) 293-3028
Freedom of Information Act Request
Please be advised that pursuant to the Illinois Freedom of Information Act (5 ILCS 140/3 et seq.), the public body
must comply within 5 working days after receipt of the request. If necessary, the City of West Chicago may
request an additional 5 days when more time is required to respond to your request for information.
I, __________________________________, hereby request on __________________the opportunity to:
(Print Name)
(Date of Request)
Check appropriate item(s):
inspect
copy the following record(s):
(Precisely describe your request to inspect and/or copy. For police records please include your
without this information your
relationship to the case, case number, date of report, time of report –
request must encompass reasonable dates, times and persons involved
):
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
There is no charge for the copying of letter and legal size documents for up to 50 pages. Charges will be: $.15 per page beyond
50 pages, $5.00 for accidents and $20.00 for reconstructed accidents; the actual costs for reproducing other records and color
prints and $1.00 for certification.
I also request that a copy of the requested record(s) be certified
Yes
No
Yes
No
Is this information to be used for commercial purposes?
_____________________________________________
______________________________________
(Signature)
Organization (if applicable)
_____________________________________________
______________________________________
Address of Requestor (City, State, and Zip Code)
E-mail Address of Requestor
_____________________________________________
______________________________________
Telephone of Requestor
Fax Number of Requestor
City Use Only
5-Day Extension:
Date Letter Sent __________
Denied Request:
Date P.A.C. Notified __________
P.A.C. Response _______________________________________________________________________
Records M anagem ent Use Only
Date Due __________
Request Routed to:
Building & Code Enforcement
Human Resources
Planning, Zoning & Engineering
Administrative Services
Public Works
Accounting
Police
City Administrator
Other ___________________
Comments: ______________________________________________
Fee:
$_________
_________________________________________________________
Date Paid:
__________
_________________________________________________________
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