Illinois Department of Natural Resources FOIA Request For Public Records

Title

Name of Requestor

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Company Name

Name of Company or Affiliation if Applicable

Street Address

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City

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State

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code

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Phone Number

Your Primary Phone Number and Extension

Fax

xxx-xxx-xxxx

Email

Email Address

Description of Requested Records

Provide as much specific detail as possible so the public body can identify the information that you are seeking.

Inspect or Copy

Inspect

Copy

Please indicate if you wish "on-site inspection" or copy the public records requested

Format of Public Records

Electronic Copies (if available)

Paper Copies

Copies Certified

No

Yes

Do you wish to have these copies certified?

Commercial Purpose

No

Yes

(21-day response period) 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)

Requesting a Fee Waiver

No

Yes

(If you are requesting that the public body waive any fees for copying the documents, you may be requested to send 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 or legal rights of the general public. 5 ILCS 140/6(c))

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