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2. 
3. FOIA - Freedom of Information Request for Public Records
5. First Name
6. Last Name
8. Company / Organization
9. Address
11. City, State, Zip Code
12. Telephone Number
14. Email
16. Description of Record(s) requested
    Try to be as specific as possible, include approximate date range, record type, etc.
18. Are you asking for these records for commercial purposes?
    -- Select One --YesNo
19. I will inspect these records at the Village Hall

    1. Yes

    Visit www.villageofdeerpark.com for regular Village Hall hours.
21. I request electronic copies be sent to the email address above if possible

    1. Yes
23. I request hard copies of these records

    1. Yes

    I agree to pay the fees (if any) for copies and/or any other costs or charges associated with this request, as set by the fee schedule below, prior to receiving the copies.
25. Pick up hard copies at the Village Hall

    1. Yes
26. Mail the hard copies to the above address.

    1. Yes
28. I request certification of the copies provided.

    1. Yes

    I agree to pay $1.00 for each document certified, which is in addition to duplication fees (if any)
30. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
31. Village of Deer Park Fee Schedule for Duplication of Public Records
    Fee Schedule
33. Electronic Signature
Leave This Blank:


37. 1. Receive an email copy of this form.
38. Email address

    This field is not part of the form submission.

39. Submit

* indicates a required field