Request for Public Records Official Form


To: Freedom of Information Officer                From: ____________________________
                                                                                        (Name of Individual)
Bourbonnais Township Park District                         ____________________________
459 No. Kennedy Drive                                                (Address)
Bourbonnais, Illinois 60914                                        ____________________________

                                                                                        (City, State, Zip)

                                                                                       ____________________________
                                                                                        (Telephone)
Dated: __________________________
                                                                                       ____________________________
                                                                                        (Name of Org. or Agency, or on behalf of)

Description of Requested Record(s):









Please indicate if you wish to inspect the above identified records or wish a
copy of them:

             _______ Inspection             ______ Copy              _______ Both

If for Inspection, name party(ies) who will be present: _____________________________________

Do you wish to have copies certified? ______ Yes _______ No

For Office Use Only:

_________________________                         __________________________________
(Date Received)                                                    (Received By)
_________________________                   _______________________________
(Date Provided to Legal Counsel For Review)           (Sent By)
_________________________                   _______________________________
(Date Response Transacted)                                  (Completed By)
_________________________                   _______________________________
(Date Response Completed)                                  (Completed By)

Notes Regarding Verbal Communications or Other Items: