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FOIA RequestPPD FRM-507 1 of 2 PLEASE PRINT LEGIBLY PLAINFIELD POLICE DEPARTMENT 14300 S. COIL PLUS DR. PLAINFIELD, IL 60544 (815) 436-6544 Fax: (815) 436-1486 FREEDOM OF INFORMATION REQUEST * * * PHOTO ID REQUIRED * * * NAME BUSINESS (IF APPLICABLE) ADDRESS CITY STATE ZIP CODE Cell or Other Telephone Number EMAIL Pursuant to the Freedom of Information Act, Chapter 5 ILCS 140, I request: a copy of to view only This request for Plainfield Police Department public records is intended for commercial purposes: commercial Description of Requested Records-(Please be specific on what you are requesting): TYPE / NATURE OF THE INCIDENT INCIDENT DATE INCIDENT TIME INCIDENT LOCATION PERSONS INVOLVED: OTHER INFORMATION: Preference: E-Mail Fax Pick-up Mail FEE SCHEDULE: No fees will be charged for the first fifty (50) pages of black and white, letter or legal sized copies of requested records. Fees for black and white copies in excess of fifty (50) pages, color copies, photo sheets, document certification, and other media are listed on the reverse side. REQUESTOR’ SIGNATURE DATE Your FOIA request will be processed within five (5) BUSINESS days after receipt of your request (21 days for commercial purpose records requests) and you will be notified by telephone when your request is complete. If we are able to honor your request, you may pick up your information at the Police Department Records window between 7:00 a.m. and 5:00 p.m. Monday through Friday. * * * DO NOT WRITE BEYOND THIS POINT * * * POLICE DEPARTMENT USE ONLY * * * Photo ID shown and Copied If Request Was Faxed, A Copy Of The Photo Id Was Included DEPARTMENT STAMP RECEIVED BY: _ Fax Email PPD FRM-507 2 of 2 FOIA OFFICER ASSIGNED: Supervisor Approval: DATE FOIA REQUEST IS DUE (DATE OF RECEIPT PLUS FIVE (5) Business Days) Approved by Village Prosecutor on Pending Court Cases: ICM Check-Case is Closed Pursuant to 5 ILCS 140, Sec 3 (e) Subsection: i ii iii iv v vi vii we are unable to supply the requested records at this time. The records will be made available to you in five (5) business days on: Entire Request Provided Partial Request Provided Entire Request Denied Cancelled by Requestor Information has been redacted or denied in accordance with 5 ILCS 140, Sec 7-1: Paragraph a; Juvenile Court, Act 705 ILCS 405 Paragraph a; All other Information Prohibited by State and Federal Laws. Paragraph b; Private Information Paragraph c; Unwarranted Invasion of Personal Privacy Paragraph d; Law Enforcement; Subsection: i ii iii iv v vi vii Paragraph e; Department of Corrections or County Jail Other: ADDITIONAL COMMENTS NOTICE OF REVIEW PROCESS: Per 5 ILCS 140, Sec 9.5(a), you may request a review of an FOIA denial by the Public Access Counselor within 60 days of the denial. The request must be made in writing, signed by you, and include a copy of the FOIA request and our response. Mail your request for review to: Public Access Counselor, Public Access Bureau, 500 S. 2nd St., Springfield IL 62706. Their telephone number is 877-299-3642, email: publicaccess@atg.state.il.us FOIA OFFICER’S SIGNATURE DATE DOCUMENTS PROVIDED QTY COST EACH SUB-TOTAL 8½ x 11 Black and White copies, per side (First 50) NO CHARGE 8½ x 11 Black and White copies, per side (over 50) $0.15 8½ x 14 Black and White copies, per side (over 50) $0.15 11 x 17 Black and White copies, per side (over 50) $0.25 8½ x 11 Color copies, per side (any amount) $0.25 8½ x 14 Color copies, per side (any amount) $0.30 11 x 17 Color copies, per side (any amount) $0.35 Certification, per document $3.00 3 x 5 Photos $1.00 8 ½ x 11 Photo Sheets $2.00 Audio Tape (each tape) $4.00 CD (each CD) $3.00 DVD (each DVD) $5.00 Video Tape (each tape) NOTE: Requestor provides sealed video tape $5.00 Crash Reports – Standard (Fee charged per 625 ILCS 5/11-416) $5.00 Crash Reports – Reconstructed $20.00 TOTAL DUE: Requestor Notified Date, Time, and Method of First Contact: Second Contact: Date, Time and Method of Contact: Reports Mailed/Emailed Denial Mailed/Emailed Date Mailed/Emailed: Requestor Failed to Pick Up Request after Second Notification Date Refiled Requestor’s Signature: Date Picked Up: Record Technician: