Section 1551.APPENDIX A Request for Public Records

TO: Freedom of Information Office State Board of Elections 1020 South Spring Street Springfield, Illinois 62708	FROM:	(Please print or type)


		Name

		Address (No P.O. Box Numbers will be Accepted)
		/
		Area Code/Telephone Number

Description of Requested Record(s)

Please indicate if you wish to inspect the records identified above or to copy them:

_______Inspect

_______Copy

_______Both

For Office Use Only:


Date Received		Date Response Due