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Freedom of Information Act Request for Public Records

Date of Request:

2/4/2012

Name of Requestor:

Street Address:

City:

State:

Zip:

Phone Number:

Fax Number:

Email Address:

Organizaton:
(if applicable)

Digital Signature:

Please describe the records you are requesting. Be very specific, including the types of records, names, addresses, dates, etc.

Is this request for a commercial purpose? No Yes

Please select your preferred method of access to the records.

Inspection at the Administration Center (No fee applies.)

Paper Copy

Number of Copies:

Delivery Method:
Pick up at the Administration Center
Mail
Fax

Certification: (The cost for certifying a record shall be $1.00 per document.)
Yes
No

(There is no charge for the first 50 pages of black and white, letter or legal sized copies. Additional copies are 15 cents per page. For color or oversized copies, the actual cost of reproducing the records will be charged. Records which must be custom copied by an outside service are available at the cost of reproduction. )

E-mail Containing Document in PDF Form (No fee applies.)

Compact Disc Containing Document in PDF Form (Fee of $0.78 per Compact Disc.)

Please uncheck this box to validate this form submission.

Having problems accessing this form? Download our printable form here.

Obtain Accessible Information or Services Here, or Call 815.727.8700 (A TDD Relay Service is Available at 800.526.0844)

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