2. Village of Merrionette Park 

   11720 S Kedzie Ave. Merrionette Park, IL 60803 

   Phone: (708)396-3183  Fax: (708) 396-3890 

    Email Merrionette Park Village Hall

4. Name*

   Individual requesting information

5. Date*
   Date
7. Phone Number*
8. Fax Number
10. Address*

    PO Box not accepted

12. Email*
14. I request the following document or documents containing the following information: *

    This is a request for information under the Illinois Freedom of Information Act, 5 ILCS 140/1, et seq. I request the  following document or documents containing the following information

16. Please Provide:*

    (Choose one)

    1. Paper copies of documents
    2. Electronic Files (if available)
    3. Inspect documents in person
17. Respond Via:*

    (Choose one)

    1. Email
    2. Mail
    3. Pick up Village Hall
    4. Pick up Fire Department
18. Purpose of your request:*

    1. Non-commercial (5 business days)
    2. Commercial (21 days)

    *A “commercial purpose” is defined under the Act as the use of any part of a public record or records, or information derived from public records, in any form for sale, resale, or solicitation or advertisement for sales or services. Please be advised that misrepresentation of the purpose of a Request is a violation of the Act. 

20. I am willing to pay fees for this request up to a maximum of $______.*

    If more than this limit, inform me first 

21. Black ink legal size copies – first 50 pages free & $0.25 per page thereafter. Actual cost applies to large formant prints and/or PDF scans. Additional charges apply for electronic media (eq. CD, DVD, Flash Drive) If not provided by requester. PD Incident reports and FD Fire reports – free of charge

23. Name*

    Typing your name constitutes your signature

24. Date*
    Date
26. *All areas must be completed in order for request to be fulfilled*
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

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