Date of Request:*

Name:*

Address:*

Address Line 2:

City:*

State:*

Zipcode:*

Contact phone number:*

Email address:*

Is this a commercial request?*

Yes

No

Please describe the public records you wish to receive. In order to expedite the search for the records, please be as specific as possible. *

The Village will respond to this request within five (5) working days.

Department:*

Police Building Public Works Clerk

Community Development Administration Finance

Signature of person making the request:

By Clicking “I agree,” you agree and acknowledge that 1) your application will not be "signed" in the sense of a traditional paper document and 2) By signing in this alternate manner, you agree that your “electronic signature” is valid and binding upon you to the same force and effect as a handwritten signature.
*

I agree