Franklin Grove Public Library
Freedom of Information Request

Requestor's Name (or business name, if applicable)          Date of Request          Phone Number

Street Address (include City, State and Zip)                     Certification requested:
                                                                                        (    ) Yes          (    ) No

Description of Records Requested:

Is the reason for this request a "commercial purpose" as defined in the Act?     (    ) Yes     (    ) No

Library Response (Requestor does no fill in below this line)

A               (    ) The documents requested are enclosed.
P               (    ) You may inspect the records at ___________________________________
P                       on the date of _______________________.
R               (    ) The documents will be made available upon payment of copying costs of $__________
O
V               (    ) For "commercial requests" only: the estimated time of when the documents
E                       will be available is ____________, at the prepaid costs stated above.
D

                 (    ) The request creates an undue burden on the public body in accordance with
                         Section 3(g) of the Freedom of Information Act, and we are unable to negotiate a
                         more reasonable request.
D              (    ) The materials requested are exempt under Section 7 _______ of the
E                      Freedom of Information Act for the following reasons:
N                     ___________________________________________________________
I                       ___________________________________________________________
E                      Individual(s) that determined request to be denied and title: _______________
D                     ____________________________________________________________
                        In the event of a denial you have the right to seek review by the Public Access
                        Counselor at (217)558-0486 or 500 S. Second St., Springfield, IL 62705
                        Or you have the right to a judicial review under Section 11 of FOIA.
                 (    ) Request delayed, for the following reasons (in accordance with 3(c) of the
                        FOIA): _________________. You will be notified by the date of __________
                        as to the action taken on your request.

NOTE: This form cannot be MANDATORY under FOIA, but it is preferred.
Failure to use it may result in the request not being properly or promptly processed.

FOIA Officer                                                               Date of Reply