Ill. Admin. Code tit. 77, pt. 500, app G, ILLUSTRATION D
Current through Register Vol. 48, No. 45, November 8, 2024
Being sufficiently informed as to the causes and circumstances of the death of the above described decedent, permission is hereby granted to cremate the body as requested.
Date____________________ (Signed)___________________, Medical Examiner / Coroner
(MEDICAL EXAMINER CORONER - WHITE) (CREMATORIUM - CANARY) (REGISTRAR - PINK) (FUNERAL DIRECTOR - GOLD)
VR-204.1 (8/89r)
Ill. Admin. Code tit. 77, pt. 500, app G, ILLUSTRATION D