Freedom of Information Request
Illinois Prairie District Public Library
208 E Partridge St. PO Box 770
Metamora IL  61548
Phone: 309-367-4594  Fax: 309-367-2687

Requestor’s Name (or business name, if applicable)                  Date of Request                          Phone number

Street Address                                                                         Certification requested: Yes           No 

City                                                                  State                Zip

Description of Records Requested:
Is the reason for this request a “commercial purpose” as defined in the Act?            Yes                 No

Library Response (Requestor does not 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. $
V (  ) For “commercial requests” only: the estimated time of when the documents will be available
E   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
E   Information Act, and we are unable to negotiate a more reasonable request.
N (  ) The materials requested are exempt under Section 7                          of the Freedom of Information Act
I   for the following reasons:
    Individual(s) that determined request to be denied and title:
    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 judicial review under section 11 of FOIA.
  (  ) Request delayed, for the following reasons (in accordance with 3(e) 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.
Grant Fredericksen, Director/FOIA Officer                                                       Date of Reply

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