2. Requester Information:
4. First Name:*
5. Last Name:*
7. Address:*
8. City:*
9. State:*
   -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
10. Zip Code:*
12. Daytime Phone Number:*
13. Email:
14. Fax Number
16. Describe the type(s) of document(s) you are requesting
18. Please describe specifically the documents you are requesting:*
20. How would you like to receive your copy?
    -- Select One --Paper (Pick-Up at IPD)EmailFax
21. Is this action solely for a commercial purpose?
    -- Select One --YesNo
23. Appeal:
    You have the right to file a written appeal to the Attorney General's Public Access Counselor within 60 days of receipt of the denial. The Public Access Counselor can be reached at 877-299-FOIA (3642) or publicaccess@atg.state.il.us.
25. Date Received:
    Date Received:
26. Date Due:
    Date Due:
28. Action Taken

    1. Compliance with request
    2. Search completed with no records located
    3. Records may be exempt with further review required
    4. Partial compliance*
29. Partial compliance*
    Pursuant to section five (5) of the Illinois Freedom of Information Act, certain material contained within the original request has been deleted or omitted because the material is exempt from disclosure under the following provision(s) of the Act above.
31. Request Denied

    1. Disclosure Prohibited by State or Federal Law
    2. Disclosure would result in an unwarranted invasion of personal privacy
    3. The records requested are exempt*
32. The records requested are exempt*
    Under the following provisions of the Illinois FOIA Act above.
34. Name:
    Personal responsible for FOIA form
35. Title:
    Personal responsible for FOIA form:
Leave This Blank:


37. Submit

* indicates a required field