Freedom of Information

Transcription

1 Freedom of Information Procedure for Requests Updated January 19, 2010

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3 VILLAGE OF MACHESNEY PARK FREEDOM OF INFORMATION ACT RULES AND REGULATIONS 5 ILCS 140/1 et seq. PROCEDURE FOR REQUESTS AND FEE STRUCTURE The following information is being provided pursuant to Section 4(b) of the Illinois Freedom of Information Act, 5 ILCS 140/4(b). All requests to inspect, copy or certify public records of the Village of Machesney Park must be submitted to the Village in writing. The Village encourages requesters to submit their requests on a form available at Village Hall and on the Village s website. The Village will review all written requests in any form. The Village will review and respond to each written request in a manner consistent with the Illinois Freedom of Information Act. Requests shall be submitted to: Freedom of Information Officer Village of Machesney Park 300 Machesney Road Machesney Park, Illinois Phone: (815) Fax: (815) lorim@machesneypark.org Fees for copies of records are as follows: Black and white copies (letter or legal size) Certification Maps (zoning, comprehensive plan or others) Village Code Book Comprehensive Zoning Plan/Book Mailing No charge for 1 st 50 pages $0.15 per page thereafter $1.00 each $30.00/large, $15.00/small $30.00 for entire book $10.00 for entire plan/book Cost of postage All fees must be paid prior to release of public records. Documents are furnished free of charge or at a reduced rate if: A reduction or waiver of fees is in the public interest in that it is for the health, safety, welfare or legal rights of the general public; and it is not for the principal purpose of personal or commercial benefit. The Village of Machesney Park will respond to every request within five (5) business days from the date of request unless the Village requires an extension pursuant to Section 3(e) of the Act. If an extension is requested or a request is denied, the Village will notify the requester in writing stating the specific reason or reasons for the extension or denial.

4 LISTING OF PUBLIC RECORDS AVAILABLE UPON REQUEST (Subject to any and all applicable exemptions) Administration. Sales tax receipts; liquor license fees; other license fees; salary schedules; administrative memoranda; correspondence received by Village; correspondence sent from Village; bidding specifications; Board policies; administrative rules and regulations; personnel code; personnel files; office equipment; insurance; capital equipment; legal notices; newspaper articles; worker s compensation records; Village vehicles; Village liens. Village Clerk. Board minutes; resolutions; ordinances; consultant contracts; contracts for capital equipment, office supplies and equipment; street maintenance and repairs; street striping; forestry; building cleaning; mosquito control; snow and ice control; garbage and recyclables; yard waste; police protection; official bonds. Building and Zoning. Fees for building and zoning permits; building inspection reports; building permits; Village maps; flood maps; comprehensive zoning plan; comprehensive plan maps; zoning ordinances; building ordinances; real estate.

5 RULES AND REGULATIONS IMPLEMENTING ILLINOIS FREEDOM OF INFORMATION ACT These Rules and Regulations (the Rules ) include the procedures, instructions, and forms for requesting public records from the Village of Machesney Park (the "Village") under the Illinois Freedom of Information Act (the Act ). The Village will respond to all written requests for inspection, copying or certification of public records in accordance with the Act, these Rules, and any and all applicable laws. Provided the request does not implicate an exemption under the Act, the Village will provide the requested public records for inspection or copying. Requests for public records or any other communication related thereto must be forwarded to the Village s Freedom of Information Officer at: Village of Machesney Park 300 Machesney Road Machesney Park, Illinois Phone: (815) Fax: (815) lorim@machesneypark.org REQUESTS FOR INSPECTION, COPYING OR CERTIFICATION OF PUBLIC RECORDS I. Officials Responsible for Responding to Requests The Freedom of Information Officer (the FOI Officer ) is the person administratively responsible for receiving and processing requests to inspect, copy or certify public records. The FOI Officer is the person with authority on behalf of the Village to grant or deny requests, to extend the response time, and to issue the appropriate notices with respect to all related matters. The FOI Officer may consult with Village staff, officials, and others as appropriate before responding to a request. The Village may, from time to time, appoint Deputy FOI Officers to assist the FOI Officer in the performance of his or her duties under the Act and these Rules. In the absence of the FOI Officer, the Deputy FOI Officers have the same authority as the FOI Officer as noted above. II. Requests A. Information. A request must be submitted to the Village in writing and in English. While the Village encourages requesters to use the form attached to these Rules ( Request Form ), the information may be submitted in any form provided the following information is included in the request: 1

6 1. The full name of the requester; 2. Contact information for the requester, such as mailing address, address, or telephone number; 3. A description of the public records requested; 4. A statement of the purpose for the request sufficient to determine whether the request is for a commercial purpose or if a fee waiver or reduction should be allowed; 5. A statement as to whether the request is from the news media or a nonprofit, scientific or academic organization; 6. A statement as to whether the principal purpose of the Request is (i) to access and disseminate information concerning news and current or passing events; (ii) for articles of opinion or features of interest to the public, or (iii) for the purpose of academic, scientific, or public research or education. B. Requests to be Complete. No request shall be deemed complete unless it contains all of the information required under Paragraph I.B.1 of these Rules. C. Submittal of Requests. Requests must be filed with the FOI Officer in accordance with the contact information provided above and may be done so by mail, facsimile, electronic mail, overnight courier service, or in person. Requests will be deemed received only upon actual receipt by the FOI Officer on a business day during business hours, regardless of the date of submission. A business day is herein defined as any day on which the Village Hall is open and staffed for regular public business. Business hours are herein defined as 8:00 a.m. to 4:30 p.m. on a business day. All Village officials and employees who receive a request for public records shall immediately upon receipt forward that request to the FOI Officer. D. Processing of Requests. 1. Upon receipt of a request, the FOI Officer must determine if the request is complete. If the request is not complete, the FOI Officer must so notify the requester within five (5) business days of receiving the request. If the FOI Officer determines that the request is complete, the FOI Officer shall indicate on the request the date and time of receipt and, if known, the date by which the Village must respond to the request. 2. The FOI Officer must maintain a copy of the request until it has been complied with or denied and must create a file for each request for public records with all related documentation, including a copy of any response by the Village and a copy of any and all communication related to the request. 2

7 3. The FOI Officer must maintain all notices of denial in a single central file that is open to the public and indexed according to the exemption asserted by the Village and, if possible, according to the types of records requested. III. Responses to Requests A. Commercial Purposes. The Village will respond to all requests made for a commercial purpose within twenty-one (21) business days. The response of the Village shall: 1. Provide an estimate of the time needed to provide the records and an estimate of the fees to be charged, which shall be paid up front before copying; 2. Deny the request based upon an exemption; 1. Advise the requester that the request is unduly burdensome and allow the requester the opportunity to reduce the request; or 2. Provide the requested records upon receipt of payment. B. Arrest Reports. The Village will respond to requests for chronologically maintained arrest and criminal history information within seventy-two (72) hours after the latest to occur of (a) the arrest that is the subject of the request, or (b) the time of receipt of the request. C. All Other Requests. For requests other than those set out in Paragraph III.A and III.B, the Village will respond within five (5) business days after a completed request is received, unless the response time has been extended pursuant to Paragraph III.D of these Rules. If the FOI Officer determines that the Act requires disclosure of all or any part of the requested public records, then the FOI Officer will notify the requester in writing either that the records are copied or that the records are ready for inspection. 1. Copies. Copies of public records approved by the FOI Officer for disclosure may be obtained during normal business hours at the Village Hall or will be mailed to the requester on request, provided that the requester has paid all applicable fees. 2. Inspection. Public records approved by the FOI Officer for disclosure may be inspected and copies obtained during normal business hours at the Village Hall upon appointment made with the FOI Officer. D. Extension of Time. If the FOI Officer determines that additional time is needed to respond to a request, the FOI Officer will notify the requester in writing within five (5) business days of receipt of the request. Said notice shall give the reason for the extension and the length of the extension, which shall not exceed five (5) business days. Requests for an extension may be made for the following reasons: 1. The public records are stored at other locations; 2. The request requires the collection of a substantial amount of records; 3

8 3. The request is categorical and requires an extensive search; 4. The records have not been located and additional time is need to search; 5. The records require examination for exemption or redaction purposes; 6. The request is unduly burdensome; or 7. Consultation with another public body or other components of the corporate body is necessary. E. Records in Electronic Format. If the request is for records maintained by the Village in electronic format, the Village shall provide it to the requester in the electronic format specified in the request, if possible. If not possible, the requester may elect to have it in the format maintained by the Village or in paper format. The Village may charge the requester for the actual cost of purchasing the recording medium. F. Audio and Video Recordings. Any requests for reproduction of public records that are contained on audio or video recordings will be responded to in accordance with the Act, the Illinois Open Meetings Act, any other applicable state statute and the Rules. The Village may charge the requester for the actual cost of purchasing the recording medium. G. Acknowledgement of Receipt or Inspection. Upon receipt or inspection of the requested public records, the FOI Officer and the requester shall acknowledge receipt or inspection by execution of the Acknowledgement Form attached to these Rules or a similar form. IV. Denial A. Categorical Requests. If the FOI Officer receives a request for all records falling within a category and the FOI Officer determines that compliance with the request would be unduly burdensome, that there is no way to narrow the request, and that the burden on the Village outweighs the public interest in the production of the records, then the FOI Officer will advise the requester in writing of the determination and the reasons therefore, and notify the requester of the right to meet with the FOI Officer to attempt to reduce the request to manageable proportions. 1. If the requester meets with the FOI Officer and the request is narrowed down to manageable proportions, then the FOI Officer shall respond to the request, as narrowed down, within the applicable response time as calculated from the date of the meeting with the requester. The response may take any form specified in Paragraph III. 2. If the requester does not meet with the FOI Officer, then the FOI Officer will deny the request using the General Notice of Denial/Partial Denial form attached hereto five (5) business days after sending the requester notice advising the requester of his or her right to meet with the FOI Officer. 3. The Village may not determine that a request is unduly burdensome should the Village fail to respond to the request within the applicable response time. 4

9 V. Fees. B. Notice of Denial. If the FOI Officer determines that a request should be denied, the Village must notify the requester in writing of the decision using the General Notice of Denial/Partial Denial form, the reasons therefore, including a detailed factual basis, and the names and titles of each person responsible for the denial. The Notice must also inform the requester of the right to review by the Public Access Counselor (PAC), including the PAC s name and phone number, and the right to judicial review. 1. If a request is denied based upon an exemption, the Notice must specify the exemption and the specific reasons for the denial, including a detailed factual basis and citation to supporting legal authority. 2. If a denial is based upon a claimed exemption under subsection 7(1)(c), for personal information contained within public records that would constitute a clearly unwarranted invasion of privacy, or 7(1)(f), for preliminary drafts, notes, recommendations, memoranda and other records in which opinions are expressed, or policies of actions are formulated, then the Village must provide notice to both the requester and the PAC of its intent to deny the request in whole or in part. The notice must include a copy of the request, the Notice of Denial/Partial Denial, and a detailed summary of the Village s basis for asserting the exemption (5 ILCS 140/9.5(b)). C. Cooperation with PAC. Should the PAC determine that further review of any denied request is warranted, the FOI Officer will comply with the directives of the PAC, or seek appropriate review, as provided in the Act. A. Amount. Unless fees are waived or reduced as provided for in Paragraph V.C of these Rules, each requester must pay the following fees for copying, certification and mailing of public records: Black and white copies (letter or legal size) No charge for 1 st 50 pages $0.15 per page thereafter Certification $1.00 Maps (zoning, comprehensive plan or others) $30.00/large, $15.00/small Village Code Book $30.00 for entire book Comprehensive Zoning Plan/Book $10.00 for entire plan/book Mailing Cost of postage For requested records that are not of a type listed above, the fees charged to the requester will be the Village s actual cost for reproducing the record. The fees stated above will not apply if the fee for the requested record is otherwise determined by statute. B. Payment. All required fees must be paid in cash, by cashier s or certified check, or by money order prior to the copying, certification and/or mailing of any public record. C. Waiver or Reduction. The fees provided above may be waived or reduced by the FOI Officer if the FOI officer is reasonably satisfied that waiver or reduction is in the public interest. Any request for a fee waiver or reduction must be indicated in the 5

10 request for public records at the time it is submitted. Subsequent requests will not be considered. The requester must include in the request for public records the specific purpose of the request in order for a fee reduction or waiver to be considered. D. Failure to Respond. If the FOI Officer does not timely respond to a complete request for public records, as provided for in Paragraph II.A., then the Village shall not require the payment of fees for any copies of records produced in response to the request. VI. Village Obligations A. Description of Village. The Village shall prominently display at Village Hall, make available for inspection and copying, send through the mail, if requested, and post on the Village website a description of the Village containing the following: 1. The membership of the Village s Board of Trustees and of all of its standing and special committees and other advisory bodies; 2. A short summary of its purpose; 3. A block diagram of the Village s functional subdivisions; 4. The total amount of the Village s operating budget; 5. The number and location of the Village s offices; and 6. The approximate number of Village part-time and full-time employees. B. Request Procedures. The Village shall prominently display at Village Hall, make available for inspection and copying, send through the mail, if requested, and post on the Village website a brief description of the methods whereby the public may request information and public records, a directory designating the FOI Officer(s), the address where requests for public records should be directed, and any fees allowable under Section 6 of the Act. C. Index. The Village must create, maintain current, and make available for inspection, copying, and mailing, a current index of all types or categories of public records prepared, received and/or maintained by the Village after July 1, The index must be reasonably detailed to assist persons in obtaining access to the public records of the Village. D. No Obligation. With the exception of the records referenced in Paragraph VI.A, VI.B, and VI.C the Village shall have no obligation under the Act or these Rules to create records that the Village does not already maintain. In addition, neither the Act nor these Rules compel the Village to interpret or advise as to the meaning of any public records. 6

11 VILLAGE OF MACHESNEY PARK REQUEST FOR PUBLIC RECORDS CHECKLIST FOR COMPLETION BY INITIAL VILLAGE RECIPIENT OF REQUEST I. Initial Receipt of Request Date of Receipt:, 20_ Time of Receipt: Method of Delivery: Personal delivery Mail delivery Electronic delivery by Delivery by facsimile Village employee receiving request (if not Freedom of Information Officer): Name: Title: _ Forwarded to Freedom of Information Officer (if applicable): Date:, 20 Time: _ Receipt by Freedom of Information Officer: Date:, 20 Time: _ TO BE COMPLETED BY FREEDOM OF INFORMATION OFFICER ONLY II. Determination of Completeness Has the requestor provided: Yes No A. Basic Information 1. His/her/its name? 2. His/her/its mailing address, address, or telephone number? 3. A description of the public records requested? If you have checked "No" to any item in this Section II.A, send notice of incomplete request in writing to the requestor within five business days after receipt by the Village of the Request.

12 If you have checked "Yes" to all items in this Section II.A, proceed to Section II.B. B. Purpose of Request Yes No Don't Know 4. Does the requestor intend to use the records, or the information derived therein, for sale, resale, solicitation, _ or advertisement for sales or services? 5. Is the requestor, or does the requestor represent, news _ media or a non-profit, scientific or academic organization? 6. Is the principal purpose of the Request is to access and _ disseminate information concerning news and current or passing events? 7. Is the principal purpose of the Request is for articles of _ opinion or features of interest to the public? 8. Is the principal purpose of the Request is academic, _ scientific, or public research or education? If you have checked "Don t Know" to any item in this Section II.B, send notice of incomplete request in writing to the requestor within five business days after receipt by the Village of the Request. In all other circumstances, proceed to Section III. III. Preparation of Response Is this request for a Commercial Purpose (circle one)? Yes / No Date Response Due: _ (either 5 or 21 Business Days after receipt by Village) Village employee responsible for compiling response: Name: Title: _ Signature of Freedom of Information Officer:

13 OFFICIAL REQUEST FORM INSTRUCTIONS AND INFORMATION 1. The information requested in Section 1 is mandatory and must be provided to allow the Village to contact you regarding your request. 2. In Section 2 describe the public records that you wish to inspect or receive copies or certified copies, and be specific as to the records that you seek. Use a separate sheet, if necessary. 3. Review the fee structure set forth in Section 3. By submitting and signing this Request Form, you agree to pay to the Village, in advance, any and all fees incurred by the Village in copying and certifying the documents you have requested. The fees may be waived or reduced by the Freedom of Information Officer upon a determination that waiver or reduction is in the public interest in that it is for the health, safety, welfare or the legal rights of the general public and is not for the principal purpose of personal or commercial benefit. A fee reduction or waiver will only be considered if Section 3.B of the Request Form is completed. 4. In Section 4, fill in the information requested regarding the purpose of the request. Such information is mandatory and assists the Freedom of Information Officer in determining whether a fee reduction or waiver is warranted and whether a request is for a commercial purpose. Pursuant to Section 3.1(c) of the Freedom of Information Act, it is a violation of the Act for a person to knowingly obtain a public record for a commercial purpose without disclosing that it is for a commercial purpose. 5. If you requested copies or certified documents, indicate whether you want those records mailed or whether you will pick them up at Village Hall. All fees must be paid prior to any records being mailed or picked up. 6. You must sign the statement set forth in Section 6. The Village will disclose the public records requested on this Request Form within 21 business days after the receipt of this Request Form for all requests made for commercial purposes, and within five business days for all other requests, unless the applicable response period is extended as provided by law or the request is denied. All extensions and denials will be in writing and will state the reasons therefore. The requestor may seek review of a denial by the Public Access Counselor of the Office of the Illinois Attorney General. Judicial review of a denial is available under Section 11 of the Illinois Freedom of Information Act, 5 ILCS 140/1 et seq. For more detailed information, please consult the Village of Machesney Park Rules and Regulations for Implementation of the Illinois Freedom of Information Act, which are available from the Freedom of Information Officer.

14 To: Freedom of Information Officer Village of Machesney Park 300 Machesney Road Machesney Park, Illinois Requestor A. Name of Requestor: _ B. Name of person for whom records are being requested (if not the requestor): C. Contact Information: Address for Responses, Decisions, and Communications: Day Telephone Number: Evening Telephone Number:_ 2. Request for Records I request the following public records of the Village: Records Requested inspect copy certify

15 3. Agreement to Pay Fees A. Unless I have requested and received a waiver under Subsection B of this Section, I will pay the following fees for the public records copied or certified at my request: Black and white copies (letter or legal size) No charge for 1 st 50 pages $0.15 per page thereafter Certification $1.00 Maps (zoning, comprehensive plan or others) $30/large, $15/small Village Code Book $30.00 for entire book Comprehensive Zoning Plan/Book $10.00 for entire plan/book Mailing Cost of postage I agree that for requested records that are not of a type listed above, the fees assessed will be the Village s actual cost for reproducing the record, including fees for paying an outside vendor to copy the record or fees for purchasing electronic medium in order to copy an electronic record. I further agree that the fees stated above will not apply if the fee for the requested record is otherwise determined by statute. B. I request a waiver of the fees set forth in Subsection A above, and in support of my request I hereby certify that I will gain no significant personal or commercial benefit from the public records herein requested and that my principal purpose in making this request is to benefit the general public by disseminating information concerning the health, safety, welfare, or legal rights of the general public in the following specific manner: _ 4. Purpose of Request Please check Yes or No for each of the following questions: Yes No A. I am requesting the public records identified in Section 1 above to use the records, or the information derived therein, for sale, resale, solicitation, or advertisement for sales or services. B. I am, or represent, news media or a non-profit, scientific or academic organization. C. The principal purpose of this Request for Public Records is to access and disseminate information concerning news and current or passing events.

16 Yes No D. The principal purpose of this Request for Public Records is for articles of opinion or features of interest to the public. E. The principal purpose of this Request for Public Records is academic, scientific, or public research or education. 5. Delivery Method I request that the City mail copies of the requested public records to me at the address set forth in Section 5 below. I hereby agree to pay all applicable fees and the actual postage for mailing before the records will be mailed. I will pick up the requested public records at the Village Hall. I hereby agree to pay all applicable fees when picking up the records. 6. Signature of Requestor By signing this Request, I acknowledge and represent that I have reviewed, and that I understand, Village of Machesney Park Rules and Regulations for Implementation of the Illinois Freedom of Information Act and that all of the information provided in support of this request is true and accurate. Date: Signature of Requestor

17 NOTICE OF APPROVAL OF REQUEST FOR PUBLIC RECORDS To: On, the Village of Machesney Park received your written request for the inspection, copying, or certification of certain Village public records. 1. Decision on Request Your request is hereby approved in its entirety. Your request is approved in part and denied in part. Those records for which your request is approved are identified in Section 2 below. Those records for which your request is denied are identified in the enclosed General Notice of Denial/Partial Denial. 2. Availability of Records Your request is approved for the following public records (the Specified Records ): The following public records will be made available for your inspection at the Village Hall as indicated in Section 3 below: Subject to payment of any required fees pursuant to Section 4 below, copies and/or certified copies of the following public records will be made available for mailing or pick up by you at the Village Hall as indicated in Section 3 below: 3. Date of Availability Your request is not for a commercial purpose. Your records will be available for inspection, copying or certification on (date not more than 5 business days after receipt of Request). Your request is for a commercial purpose. Your records will be available for inspection, copying or certification on. (date not more than 21 business days after receipt of Request).

18 4. Appointment for Inspection or Pick-up The Specified Records will be made available for inspection or pick-up at the Village Hall, 300 Machesney Road, Machesney Park, Illinois You must call the Freedom of Information Officer at the Village Hall at (815) to schedule an appointment for inspection or pick up of the Specified Records. If, within five (5) business days after the date of this Notice of Approval, you have not made an appointment to inspect or pick up the Specified Records, then the Specified Records will be re-filed and will be made available to you only upon the filing of a new Request for records. 5. Copying and Certification Fees No copies or certified copies of the Specified Records will be provided to you until the following applicable fees have been paid. Fees must be paid in cash, by cashier s or certified check, or by money order. Letter or legal size Black and White Copy Cost: First 50 Pages: Free Additional Pages: Certification Cost: Reproduction of Electronic Medium Cost: Outside Vendor Cost: Other Actual Reproduction Cost: Cost as Fixed by Statute: Total Fee: $ (_ sides at $ 0.15 per side) $ ( documents at $1.00 each) $ $ (see attached invoice) $ (see attached invoice) $ $ The following provisions marked with an x apply to your request: Your fees have been paid in full. Your request for a fee waiver or reduction has been approved in the following amount: $ Your request for a fee waiver or reduction has been denied. You have previously deposited the following amount: $_ A balance is now due in the following amount: $_ Dated:, 20_ THE VILLAGE OF MACHESNEY PARK By: _ Freedom of Information Officer

19 GENERAL NOTICE OF DENIAL/PARTIAL DENIAL OF REQUEST FOR PUBLIC RECORDS To: On _, the Village of Machesney Park received your written request for inspection, copying, or certification of certain Village public records. 1. Denial of Request Your Request is hereby denied in its entirety. The reason(s) for denial are stated in Paragraph 5 below. Your Request has been denied in part. The records for which your request is denied are identified below. (The records for which your request is approved are identified in the enclosed Notice of Approval.) Your Request is denied as to the following records (the Specified Records ): 2. Responsible Official The Village s Freedom of Information Officer is the official responsible for this denial. 3. Notice of the Right to Review by Illinois Attorney General You have the right to file a request for review of your request and this Notice of Denial by the Public Access Counselor of the Office of the Illinois Attorney General. The Public Access Counselor may be contacted at 500 South 2nd Street, Springfield, Illinois 62706, or by telephone at (217) Notice of Right to Judicial Review Under Section 11 of the Illinois Freedom of Information Act, 5 ILCS 140/11, you have the right to seek judicial review of this denial. The Village cannot advise or represent you in this matter. You should consult your own legal counsel.

20 5. Justification for Denial Your Request is being denied with respect to the Specified Records because the Specified Records are exempt from disclosure pursuant to the Illinois Freedom of Information Act for the following reason or reasons (references are to sections of the Act): Dated:. THE VILLAGE OF MACHESNEY PARK By: Freedom of Information Officer

21 ACKNOWLEDGMENT OF INSPECTION OR RECEIPT OF PUBLIC RECORDS To: Pursuant to your request for the inspection, copying, or certification of certain Village public records dated _, you have been provided with the right to inspect, or copies of, the following public records in accordance with the Illinois Freedom of Information Act: The Village has received $ from you in the form of cash, a cashier s or certified check, or a money order, in payment of all fees related to your request. Dated:, 20_ THE VILLAGE OF MACHESNEY PARK By: _ Freedom of Information Officer TO BE COMPLETED BY REQUESTOR I,, hereby acknowledge that I have been provided with the right to inspect or copies of the public records listed above on. In the event that I have been denied the right to inspect or copy other public records, this acknowledgment will not in any way affect my right to appeal the denial. _ Signature of Requestor

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23 STATE OF ILLINOIS ) ) SS. COUNTY OF WINNEBAGO ) PROOF OF SERVICE I,, being duly sworn on oath, state that on this _ day of,, on or about the hour of.m., I personally delivered or mailed the foregoing document entitled _ by: Personally handing it to the person to whom it is addressed. Delivering it to the property located at: which property is believed by me to be the residence, office, or other location of the person to whom the document is addressed. Placing it in an envelope addressed to the person to whom it is addressed at the address to which it is addressed and depositing said envelope, with proper postage affixed, in the United States post office or mail box located at: Signed: Subscribed and sworn to before me this day of, 20. NOTARY PUBLIC