CITY OF WEST CHICAGO FREEDOM OF INFORMATION ACT REQUEST To: Valeria Perez Freedom of Information Officer 475 Main Street West Chicago, Illinois 60185
I,__________________________________ hereby request the opportunity to: (Print Name) Circle appropriate item(s): inspect copy the following record(s): (Precisely describe your request to inspect and/or copy):
I also request that a copy of the requested record(s) be certified _______ Yes ________ No I understand that I may be charged 25¢ per page for copying letter size and legal size documents; the actual cost of reproducing other records; and 25¢ per document for certification. I further understand that these records are not to be used to further a commercial enterprise. Please be advised that pursuant to the Illinois Freedom of Information Act (5 ILCS 140/3 et seq.), the public body must comply within 7 working days after receipt of the request. If necessary, the City of West Chicago may request an additional 7 days when more time is required to respond to your request for information. ______________________ Date of Request _____________________________________________ (Signature) _____________________________________________ Print Name _____________________________________________ Business Name _____________________________________________ Address of Requestor (City, State, and Zip Code) _____________________________________________ Telephone Number of Requestor DO NOT WRITE IN THIS SPACE: _____________________________________ (Date request received by public body to be filled in by compliance officer.)
*RETURN COMPLETED FORM TO: VALERIA PEREZ, FREEDOM OF INFORMATION OFFICER, CITY OF WEST CHICAGO, 475 MAIN STREET, WEST CHICAGO, IL 60185 OR FAX 630-293-3028 – ANY QUESTIONS CALL 630-293-2200 EXT. 170.