Huntley Park District Freedom of Information Act (FOIA) Request Form

The Huntley Park District makes every effort to comply with the State of Illinois Public Freedom of Information Act (FOIA) that all persons are entitled to full and complete information regarding the affairs of government and the official acts and policies of those who represent them as public officials and public employees consistent with the terms of this Act. FOIA requests may be submitted to the Administration office in-person or by mail to 12015 Mill St. Huntley, IL 60142, faxed to (847)669-2836 or e-mail to scrowe@huntleyparks.org. Freedom of Information Request Forms may be obtained by calling (847)669-3180 or downloaded from the District’s website www.huntleyparks.org.

Date of Request

Date

Name of Requestor*

First NameLast Name

Name of Organization/Business (if applicable)

Address of Requestor*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Daytime Phone Number*

Please enter a valid phone number.

Email*

example@example.com

Pursuant to the Freedom of Information Act, 5 U.S.C. 552, and the Privacy Act, 5 U.S.C. 552a, Privacy Act, 5 U.S.C. 552a, I hereby request access to the records listed below.

Describe in detail the subject or document(s) containing the information requested – be as specific as possible.*

Will the information requested be used for commercial purposes?*

YesNo

The first 50 pages for black and white, letter or legal sized copies (8 ½ x 11 or 11 x 14), are available free of charge. A fee of .15₵ per page, which is reasonably calculated to reimburse the Park District for the actual costs of reproducing or certifying the public records, will be charged for copies exceeding 50 pages.

Are you requesting a fee waiver?

YesNo

If you are requesting a fee waiver, please state your reason below:*

The Park District will respond to your request within five (5) business days (21 business days for commercial requests) as provided by law. If your request is denied in whole or in part, justification for withholding records will be provided to you. Any segregated portions that are not exempt will also be disclosed to you.

Upon completion of my request:*

Call me at the number listed aboveEmail me at the email listed aboveMail response to address listed aboveFax response to following contact below

Fax Number*

Please enter a valid phone number.

Signature of Requestor*