Village of Glasford

FOIA REQUEST

Village of Glasford Form FOIA

Date Requested:

Request Submitted By:

E-mail

U.S. Mail

Fax

In Person

Name of Requester:

Street Address / PO Box:

City/State/Zip(required):

Telephone Number:

E-mail (Optional):

Fax (Optional):

Records Requested and Reason: *Provide as much specific detail as possible so the public body can identify the information that you are seeking. You may attach additional pages, if necessary.

Do you want copies of the documents?

YES

--Do you want

Electronic Copies

Paper Copies?

--If you want Electronic Copies, in what format?

Is this request for a Commercial Purpose?

YES

NO (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)).

Signature of requester:

**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.**

Name

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