TITLE 77: PUBLIC HEALTH
CHAPTER I: DEPARTMENT OF PUBLIC HEALTH
SUBCHAPTER e: VITAL RECORDS
PART 500 ILLINOIS VITAL RECORDS CODE
SECTION 500.APPENDIX G DEATH RECORDS



Section 500.APPENDIX G   Death Records

 

Section 500.ILLUSTRATION A   Report of Death

 

Illinois Department of Public Health

Division of Vital Records

REPORT OF DEATH

FUNERAL DIRECTOR

NAME OF DECEASED

DATE OF DEATH

PLACE OF DEATH (STREET OR INSTITUTION)

CITY

COUNTY

VETERAN

 YES   NO

PLACE OF DISPOSITION (NAME AND LOCATION OF CEMETERY, CREMATORY)

 

CREMATION 

SHIP OUT OF STATE 

CORONER OR MEDICAL EXAMINER 

 

IF ANY OF THE ABOVE ITEMS ARE CHECKED, THIS PERMIT MUST BE SIGNED BY THE LOCAL REGISTRAR PRIOR TO DISPOSAL OF THE BODY

NAME AND ADDRESS OF PHYSICIAN WHO WILL SIGN DEATH CERTIFICATE

 

I CERTIFY I HAVE CONTACTED THE PHYSICIAN AND HE/SHE WILL SIGN DEATH CERTIFICATE

 

 

SIGNED  _______________________________________________________, FUNERAL DIRECTOR

FUNERAL HOME NAME AND ADDRESS

 

 

 

(SEE REVERSE SIDE FOR INSTRUCTIONS)

 

VR205 (8/89)                                                                                                                                                          PART 1

 

 

INSTRUCTIONS TO FUNERAL DIRECTORS

 

1.            In every case a Report of Death must be mailed (or otherwise filed with) the Registrar of the District in which death occurred within 24 hours of taking possession of the body.

 

2.            If the body is to be cremated, shipped out of state or is a Coroner/Medical Examiner case, a permit signed by the Registrar must be obtained prior to final disposal of the remains.

 

3.            A corrected death certificate must be filed with the Registrar where the death occurred in order to receive a signed permit as required in (2) above.  In all other cases a completed death certificate must be filed with the Registrar where the death occurred within seven (7) days from the date of death.

 

(Source:  Added at 15 Ill. Reg. 11706, effective August 1, 1991)