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Freedom of Information Act Record Request Form

  1. Office of Village Clerk Kristy Merrill
    2121 W Lake Street
    Hanover Park, IL 60133
    Phone: 630-823-5602
    Fax: 630-823-5786
  2. Record Request Form
    If you do not use this form for requests for inspecting or copying of Public Records pursuant to the Freedom of Information Act, you must provide your request in writing. For Requests for Fire Department Medical Reports & Billing, please contact: Andres Medical Billing 3323 N. Ridge Avenue Arlington Heights, Illinois 60004 1-847-577-8811
  3. Please provide the information below completely to determine the record requested.
  4. Persons Involved
  5. Do you want copies made?*
  6. Financial Record Use*
    Will you use part or all of the records: to sell, to solicit, or advertise for sales, services, or commercial purposes?
  7. Record Use*
    Are you any of the following: news, not-for-profit, scientific or academic institution?
  8. Signature of Requestor*
    By selecting I agree option below you are giving your electronic signature.
  9. Office Use Only
    Forward to the the FOIA Officer immediately upon receipt. Note date received.
  10. Leave This Blank:

  11. This field is not part of the form submission.