§ 38.03 REQUEST FORM.

   CITY OF MATTOON

   CITY HALL

   MATTOON, ILLINOIS

   On the           day of              , 20    , at the hour of               M., the following individual(s) appeared in person at the office of the (Police Chief)-(City Clerk) and asked to inspect the following records:

   Individual (s) making the request:

   Records sought to be inspected:

   The above records were presented to such individual (s) for inspection at                 M. on the        day of           , 20    , except for: (here insert any records not presented:)

   The reason(s) for not providing the above records (or portion of records) was                                                                                                

   Of the records requested, copies of the below records were provided to or made by the individual(s) making the request:

   Date and Time of Memorandum:                                                                               

   Signature of Employee:                                                                                     

   Title of Employee:                                                                                         

   Witness:                                                                                                   

(Ord. 84-1498, passed 6-19-1984)