Glen Carbon Centennial Library, 198 S. Main Glen Carbon, IL 62034 - (618)288-1212 Fax (618)288-1205
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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. 
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
Glen Carbon Centennial Library Freedom of Information Request
 
Library Response (Requestor does not fill in below this line)

     A
    P
    R
    O
    V
    E
    D
     (  )     The documents requested are enclosed.

     (  )     You may inspect the records at _________________________________________
               on the date of .

     (  )     The documents will be made available upon payment of copying costs of  $_________.

     (  )     For “commercial requests” only: the estimated time of when the documents
               will be available is _______________, at the prepaid costs stated above.


      D
     E
     N
     I
     E
     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.

     (  )     The materials requested are exempt under Section 7  of the EFreedom of Information
               Act 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 theFOIA):_____
              You will be notified by the date of ____________as to the action taken on your request.
FOIA Officer

 Date of Reply