Foia Request Form - Village Of Sherman printable pdf download

FOIA REQUEST FORM - VILLAGE OF SHERMAN

Request for information from the Village of Sherman under the Illinois Freedom of Information Act

PLEASE PRINT ALL INFORMATION NEATLY AND LEGIBLY

FOIA Request Number: Indicate Year: _____ FOIA Number: _____________

Last Name ____________________________________ First _____________________________ M.I. _______

Street Address______________________________________________________________________________

City _______________________________________________ State ______________ Zip Code ____________

Phone ______/______________ 2nd Phone ______/______________ Email: ___________________________

IS THIS REQUEST FOR COMMERCIAL PURPOSES? (circle one)

YES

Under the Illinois Freedom of Information Act, I hereby request (check one) ___ a copy, or ___ to inspect, the

following records (list records sought to be inspected, or attach to request, include Police Report # if known):

__________________________________________________________________________________________

Date/Time Records Requested: _____________________ ______ __________ ___________

Month Day Year Time

Signature of individual making request: ______________________________________________

Acknowledgement of Receipt (please print legibly): I, ______________________________, hereby verify that

I received copies of, or have inspected those records requested, on the date so noted in compliance with

provisions of the Illinois Freedom of Information Act.

Signature: ___________________________________________ Date: ___________________

Attach to this request for the file, copies of all documents provided to requestor, or provided for inspection.

FOR OFFICE USE ONLY

This FOIA request was submitted on: _________________________

Fee: _____________________________

This FOIA request was received on: _________________________

By: _____________________________

Response to this FOIA Request due: _________________________

Notification By/Date: ________________

Requested records provided on: _________________________

By: _____________________________

The requested records have been reviewed and are appropriate for release under the guidelines of the Illinois Freedom

of Information Act except as described in Village response letter.

List names and titles of all persons authorizing denial and specify exact section of the Illinois FOIA, which applies:

_____________________________________________________________________________________________

Signature of Freedom of Information Act (FOIA) Officer: ____________________________________ Date ___________

Check One:

USPS mailed. Email Picked Up

The requested records were presented or inspected by requestor at (location): _________________________________

or mailed by USPS at _____________, on ______________ _________________ ________________

(Time)

(Month)

(Day) (Year)

Village of Sherman Illinois FOIA Request Form (Rev.2014‐1)

Foia Request Form - Village Of Sherman