Freedom of Information Act Request Form

Village of DeSoto

210 West Lincoln Street, PO Box 467

DeSoto, IL  62924

618-867-2315

618-867-2696 fax

villageofdesoto.com

Date of Request _______________________________________________________

Requestor’s Name  _____________________________________________________

Company  ____________________________________________________________

Address  ______________________________________________________________

City, State, Zip Code  ___________________________________________________

Telephone Number  _____________________________________________________

Email Address  _________________________________________________________

I, the undersigned, do hereby request copy(s) that are maintained by the Village of DeSoto, Illinois, which pertain to (be specific):  ______________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Requestor’s Signature  _______________________________________________________________

Note:  Please be reminded all applicable fees must be prepaid.  Therefore, if you would like copies mailed to you, we will contact your about the total price of the copies, certification, postage, etc., prior to mailing in order that you may remit payment.  After receipt of payment, your copies will be mailed.  To avoid a delay in receiving your copies, it is recommended that you retrieve your copies at the DeSoto Village Hall once they become available.

If your request is denied, you may file an appeal to:  Public Access Appeal Officer, Illinois Attorney General, 100 West Randolph, 12th Floor, Chicago, IL  60601.

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(For Department Use Only)

Date request was received                        ___________________  By  _______________________

Records made available (Date)                 ______________________________________________

Request denied, and reason                      ______________________________________________

                                                                ______________________________________________

Copies made:   ____  yes    ____ no

Number:    ___________________

Fee Paid $ ___________________