Ill. Admin. Code tit. 77, pt. 500, app G, ILLUSTRATION D
Current through Register Vol. 49, No. 2, January 10, 2025
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