Section 2525.APPENDIX A Request for Public Records

TO:	Illinois Medical District Commission 600 South Hoyne Chicago, Illinois 60612 ATTN: Executive Director		FROM:
				NAME
				ADDRESS
				AC /
				TELEPHONE
DESCRIPTION OF REQUESTED RECORDS
Please indicate if you wish to inspect the records identified above or wish to copy them:
Inspect		Copy			Both

FOR OFFICE USE ONLY:
Date Received				Date Response Due

(Source: Amended at 29 Ill. Reg. 20428, effective December 31, 2005)