FOIA 2010form

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					                                      Freedom of Information
                                 Request for Production of Records


To:      Holly Richards Sorensen                  Date: ___________________________
         Library Director
         Des Plaines Public Library
         1501 Ellinwood Street
         Des Plaines, IL 60016-4553


I hereby request production of the following records: (Describe using reverse side if
necessary, or attach separate sheet.)
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________


Check which of the following apply:


______         I will inspect these records at the Des Plaines Public Library.


______         I request copies of the following records, and agree to pay per fee schedule.
                ____________________________________________________________________________
                ____________________________________________________________________________
                ____________________________________________________________________________
                ____________________________________________________________________________
______         Please certify the following documents per fee schedule.
                ____________________________________________________________________________
                ____________________________________________________________________________
              ____________________________________________________________________________
              ____________________________________________________________________________


The records requested are to be used for commercial purposes: _____yes _____no


Name: __________________________________
Address: ________________________________
_________________________________________
Phone
Work: ___________________________________
Home: __________________________________
Cell: ____________________________________
Representing: __________________________
_________________________________________




                      Des Plaines Public Library – Freedom of Information


Any person requesting records of the Des Plaines Public Library may make such a written
request either by mail, personal delivery, fax, email or other means to the attention of Holly
Richards Sorensen, Library Director. Requests will be directed to Carol Kidd, Administrative
Assistant, if Library Director is unavailable.


Address: Des Plaines Public Library, 1501 Ellinwood Street, Des Plaines, IL 60016-4554
Email: hsorensen@dppl.org or ckidd@dppl.org
Fax: 847-827-4161


Fees:
The first 50 pages of black and white letter or legal sized copies – no charge
Additional pages $.15 per page
Color pages will be charged for actual cost of reproduction
Certification fee is $1.00
If electronic format is requested, fee will be charged only for cost of the medium e.g. disc,
diskette, etc.


“Request for Production of Records” Form may be used but is not required. May obtain
from Administration.


FOIA OFFICE – one of the responsibilities of the Library Director, Administration Department.


Purpose: To receive FOIA request and to send responses in compliance with FOIA.
FOIA Officers – Holly Richards Sorensen, Library Director and Carol Kidd, Administrative
Assistant.
Budget: No specific budget assigned.
Number of employees: Not exclusive responsibility of any single employee. Requests will be
processed by Library Director with assistance by designated management staff and
administrative assistant as appropriate and needed.

				
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posted:9/30/2012
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