Freedom Of Information Act Request Form printable pdf download

Rolling Meadows Park District

Freedom of Information Act

Request Form

REQUESTOR INFORMATION:

Name: _____________________________ Address: _________________________________________

Telephone: __________________________Email address: _____________________________________

Records Requested:

*Provide as much specific detail as possible so the Park District can identify the information that you

are seeking.

_____________________________________________________________________________________

Date Requested: _____________ Signature: _________________________________________________

Request Submitted By: _____E‐mail _____U.S. mail _____ Fax _____ In Person

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; 5 ILCS

140.3.1(c)).

OFFICE USE

Due Date: ________________ Extension Date and Reason: _____________________________________

Reason for not providing records: _________________________________________________________

_____________________________________________________________________________________

Copies of the following records were provided to the individual making the request: ________________

_____________________________________________________________________________________

Paper Copy Cost: ________________

Payment method: ________________

(over 50 paper copies)

Electronic Copy Cost: _______________ Payment method: _____________________

FOIA Officer and title: ________________________________________

06/04/14

CPK

\\RMPD‐DC02\AdminOffice\Manuals (Master Copies)\Forms\Freedom of Information (FOIA) form 2014.docx

Freedom Of Information Act Request Form