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Freedom of Information (FOIA) Form

  1. 310 E. Torrance Ave., Pontiac, IL 61764
    Livingston County Health Department
  2. Jackie Dever, R.N., BSN

    Administrator 

  3. FREEDOM OF INFORMATION REQUEST
  4. Requester:
  5. Is this request for Commercial Purpose*

    (It is a violation of the Freedom of Information Act for a person to knowingly obtain a public record for a commercial purpose without disclosing that it is for a commercial purpose, if requested to do so by the public body. 5/140.3.1(c).

  6. Are you requesting a fee waiver?*

    If you are requesting  that the public body waive any fees for copying documents, you must attach a statement of the purpose and whether the request is to access or disseminate information regarding the health, safety and welfare or legal rights of the general public.  5 ILCS1 40/6 (c).

  7. For Agency Use Only
  8. Received by:
  9. Agency: Livingston County Health Department
  10. Address: 310 E. Torrance Avenue, Pontiac, IL 61764
  11. Phone Number: (815) 844-7174
  12. Response:
  13. Livingston County Public Health Department does not discriminate in admission to programs or activities or treatment of employment in programs or activities in compliance with the Illinois Human Rights Act, The U.S. Civil Rights Act,: Section 504 of the Rehabilitation Act; the Age discrimination Act; The Age Discrimination in Employment Act; and the U.S. and Illinois Constitution and the American with Disabilities Act. If you feel you have been discriminated against you have a right to file a complaint with the Livingston County Public Health Department, (815) 844-7174.
  14. Leave This Blank:

  15. This field is not part of the form submission.