TO:

FROM:

Office of Press/Communications

Name:

Address:

Illinois Department of Human Services

100 South Grand Ave. E., 3^rd Floor

Phone:

Attn:  FOIA Request

DESCRIPTION OF REQUESTED RECORDS:

Please indicate if you wish to inspect the above captioned records or wish a copy of them:

  Inspection

  Copy

  Both

FOR OFFICE USE ONLY:

Date Received

Date Response Due