Ill. Admin. Code tit. 2, § 2701.APPENDIX A – Office of Public Counsel Request for Public Records

Date of request:
Name:
Mailing address:


City, State, and zip code:
Daytime (8am-5:30pm) telephone number:
Whom are you representing?

Please state the specific purpose for the request:





Please identify the information that you would like to review:






Please state how you would like to review this material (circle the appropriate number):
	1.	I would like to inspect, but not copy, this material.
	2.	I would like a copy of this material.
	3.	I would like to inspect and copy this material.

If you want a certified copy of any of the documents that are being copied, please identify
which documents you want certified:




Additional comments:




Please sign your name		Date of signature