MONROE COUNTY SHERIFF’S OFFICE
PUBLIC INFORMATION REQUEST FORM*
**Note to Requestor: 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**
Request No. ______
Date: ______
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)).
Describe the records you request: *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.
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Requestor Name: ______Address: ______
Phone: ______City/State/Zip: ______
Email: ______
How do you prefer to receive the information: Paper Electronically
If electronically, is there a format you prefer? Yes No
If yes, please describe format: ______
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OFFICIAL USE ONLY – DO NOT WRITE BELOW THIS LINE
Date/Time Received: ______By: ______
Official Business Date Received: ______Response Due Date: ______
Approved & Provided Denied Denied in Part; Approved in Part
Logged Response Given Request Closed ______
FOIA Officer Signature
* The use of this form is not mandated. It is offered for the convenience of requestor. The Monroe County Sheriff’s Office will accept any written requests for information. Only written requests will be considered. Private information will not be disclosed under a Freedom of Information Request.