FOIA Request Form






Requestor's Name _____________________________________    

Date of Request _______________________________________

Phone Number ________________________________________


Certification Requested  _________yes  ____________ no

Description of Records requested _____________________________________________________


Is the reason for the request a "commercial purpose" as described in the Act ? ___________

Library response (Requestor does not fill in blow this line)



A      ( ) The documents requested are enclosed.

P      ( ) You may inspect the records at

P           on the date of _________________________________.

R      ( ) The documents will be made available upon payment of copying costs of

O           $ _____________________.


E      ( ) For commercial requests only:  the estimated time of when the documents

D           will be available is _______________, at the prepaid costs stated above.



            ( ) The request creates an undue burden on the public body in accordance with

              Section 3(g) of the Freedom of Information Act, and we are unable to negotiate a more   reasonable  request.

D          ( ) The materials requested are exempt under Section 7 of the

E                 Freedom of Information Act for the following reasons:

N            _________________________________________________________________________________

I            __________________________________________________________________________________

E           Individual(s) that determined request to be denied and title: _________________________________

D          __________________________________________________________________________________ .

            In the event of a denial, you have the right to seek review by the Public Access

            Counselor at (217) 558-0486 or 500 S. Second St., Springfield, IL 62705

           Or you have the right to judicial review under section 11 of FOIA.

     ( ) Request delayed, for the following reasons (in accordance with 3(e) of the FOIA): . You will be notified by the date of _____________ as to the action taken on your request.




NOTE: This form cannot be MANDATORY under FOIA, but it is preferred. Failure to use it may result in the request not being properly or promptly processed.

FOIA Officer                                                                                        Date of Reply

 __________________________________________           _____________________________