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2. 
4. First Name*
5. Last Name
7. Address, City, State, Zip
9. Email Address*
10. Phone Number
12. Request:

    Please be as specific as possible, describing in detail the record(s) or material you are requesting. Furnish names, dates and incidents when possible. 

14. I request: *
16. Commercial Request?*
    -- Select One --YesNo

    Is this request being made for a commercial purpose? 

    _{Under Section 3.1(c) of the Freedom of Information Act, it is a violation of the Act for a person to knowingly obtain a public record for a commercial purpose without disclosing that it is for a commercial purpose.}

17. Method Of Response*
    -- Select One --Inspection of Record(s) Only Mail copy to addressPick-Up at Village HallElectronic Copy

    Please indicate how you would like to obtain the above referenced record(s):

19. Requestor Ackowledgement and Certification

    I certify that the information provided in this request is true and accurate to the best of my knowledge and understand that this request will be reviewed and processed in accordance with the Illinois Freedom of Information Act.

20. Electronic Signature*
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22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field