To:

Freedom of Information Officer

Department of Natural Resources

One Natural Resources Way

Springfield, IL  62702-1271

From:

Name

Address

Phone Number

(Between 8:30 a.m., Monday – Friday)

Description of Requested Record(s):

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

Inspection

Copy

Both

Do you wish to have these copies certified?    Yes      No

Requestor's Signature

Date