Township Of Schaumburg - Request for Public Record Form

Request for Public Record Form
Freedom of Information Act, Authority: 5 ILCS 140, et seq.
If you prefer to print out and mail this form with your payment please mail it to:

 Township of Schaumburg
One Illinois Blvd.
Hoffman Estates, IL 60194

Please complete the following information. 

*Required Form Fields.
Requestor’s Name:*
Requestor’s Address:
Requestor’s Phone No:
Requestor’s Fax No:
Email Address:*


PLEASE ALLOW SEVEN (7) WORKING DAYS TO PROCESS ALL REQUESTS
 

Information Requested
(Please be specific with your request)
 
Describe Item Requested:
 
Date(s) of Occurrence:
 
I wish to inspect these records at the Township Offices on .

Date                          

I request copies of the following records, and agree to pay $.25 per page therefore.

(If requesting copies of all records listed above, state “all”).
 
Please certify the following documents.

(I agree to pay $.50 for each document certified, which is in addition to the costs per page).
 
I warrant and represent that the records requested will not be used for purposes of furthering any commercial enterprise.
 
INFORMATION RECEIVED:


DATE
 
PRINT NAME
 
SIGNATURE
 

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Township Of Schaumburg · One Illinois Blvd · Hoffman Estates, IL 60169 · (847) 884-0030
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