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Freedom of Information Act (FOIA) Request Form

2. I hereby request the right to inspect, or obtain copies of, the following public records of the Village: Describe in detail records requested and information you are seeking.

   Include applicable time periods.

4. Records Requested From*

   1. Administration
   2. Community Development
   3. Fire Department
   4. Finance Department
   5. Police Department
   6. Public Works
   7. Water and Electric

5. Form Records*

   1. Electronic
   2. Inspection Only
   3. Paper

7. If Necessary, Attach a Separate Sheet:

9. Is this request is for a commercial purpose?*

   1. Yes

   1. No

   A commercial purpose means the use of any part of the public records or information derived from the records in any form, for sale, resale, or solicitation or advertisement for sales or services.

11. I agree to pay the charges for reproducing the documents as outlined in the Guidelines for Submitting a Request for Records. If the services of an outside vendor are required to copy any public record, I agree to pay the charges that the Village incurs in connection with such copying fees (fees may be payable in advance).

13. First Name*

14. Last Name*

15. Phone Number*

17. Address*

19. City*

20. State*

21. Zip Code*

23. Email Address*

25. Response Date
    Response Date

26. Responding Department(s)

    1. Administration
    2. Community Development
    3. Fire Department
    4. Finance Department
    5. Police Department
    6. Public Works
    7. Water and Electric

28. Request Status
    -- Select One --GrantedPartialDeniedWithdrawn

29. Exemptions

31. File

32. Notes

Leave This Blank:


33. Submit

* indicates a required field