Freedom of Information Request Form

Requestor's Name Date Address Telephone Number City Zip Code Secretary of State Employee Name, Title & Department to Receive FOI Request: Department Name Title RECORDS SOUGHT (Be Specific): Requestor's Signature The department will respond to a request for public records within seven (7) working days after its receipt. If your request is denied, you may file an appeal. Appeals should be addressed to the Assistant Secretary of State, 208 Capitol, Springfield, Illinois 62756. (FOR DEPARTMENT USE ONLY) Response: Department ______________________ Records Made Available Date _______________ Copies Made Yes No Request denied and why? ______________________ How many? ______________________ Fee ____________________________ Other (Attach Correspondence): Department Comments (Use Reverse) Date Request Received