FOIA Form

records regarding performance of emergency medical services are not subject to disclosure under the Freedom of Information Act. Disclosure of such records is governed by the disclosure procedures found in 735 ILCS 5/8-802. ALFALFA FIRE DISTRICT FREEDOM OF INFORMATION ACT WRITTEN REQUEST FOR RECORDS FORM 1

Name (required)

Adress (required)

City (required)

State (required)

Zipcode (required)

Dear Fire Chief (or designee): (I), (We), are hereby requesting that (I) (We) Inspect the following records at the Alfalfa Fire District’s Administrative Office. Receive copies of the following records from the Alfalfa Fire District. (Please be specific in listing records.)

Specific Record(s) Requested (required)

Will the records received or requested or the information derived thereof be used in any form of sale, resale, or solicitation or advertisement for sales or services? Yes/ No. I understand that if I request that the records be copied, I may be charged a fee due in full before the copies are made. (required)

Signature(s) of Requester(s) (required)

Date Request Made (required)

Date Needed By (required)

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