Freedom of Information Act (FOIA) Request

	First Name:*

	Last Name:*

	Company Name

	Street Address:*

	City:*

	State: *

	Zip Code:*

	Phone:*

	Email:*

	Fax:

	Records Requested: (Provide as much specific detail as possible so the public body can identify the information that you are seeking).

	Do you want electronic or paper copies of the document?*
	Do you want electronic or paper copies of the document?* Paper Electronic

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

	Are you requesting a fee waiver? (If you are requesting that the public body waive any fees for copying the documents, you must attach a statement of the purpose of the request, and whether the principal purpose of the request is to access or disseminate information regarding the health, safety and welfare of legal rights of the general public. 5 ILCS 140/6(c)).*
	Are you requesting a fee waiver? (If you are requesting that the public body waive any fees for copying the documents, you must attach a statement of the purpose of the request, and whether the principal purpose of the request is to access or disseminate information regarding the health, safety and welfare of legal rights of the general public. 5 ILCS 140/6(c)).* YesNo

	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. * Required Information

Done