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2. *Note to Requester: Retain a copy of this request for your files. If you eventually need to file a Request for Review with the Public Access Counselor, you will need to submit a copy of your FOIA request.
4. Date of Request*
6. Name of Requester*
8. Street Address*
9. City/State/County/Zip*
11. Telephone #*
12. Email*
14. Records Requested*
    Provide as much specific detail as possible so the public body can identify the information that you are seeking.
16. Additional pages
    If necessary, additional pages may be attached.
18. Do you want copies of the records?*

    1. Yes
    2. No
19. If yes, do you want

    1. Electronic Copies
    2. Paper Copies

    Electronic copies will be sent as a .pdf.
21. Is this request for a commercial purpose?*

    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 commerical purpose, if requested to do so by the public body. 5 ILCS 140.3.1(c)).

    1. Yes
    2. No
23. If yes, identify commercial purpose
25. Are you requesting a fee waiver?*

    If you are requesting that the public body waive any fees for copying the records, you must explain the request below 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)).

    1. Yes
    2. No
27. If yes, explain request for fee waiver
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field