Illinois Administrative Code (Last Updated: March 27, 2024) |
TITLE77. PUBLIC HEALTH |
PART500. ILLINOIS VITAL RECORDS CODE |
Section500.APPENDIX G. Death Records |
§500.ILLUSTRATION E. Application for Disinterment – Reinterment Permit
-
STATE OF ILLINOIS
DEPARTMENT OF PUBLIC HEALTH – OFFICE OF VITAL RECORDS – SPRINGFIELD 62761
APPLICATION FOR DISINTERMENT – REINTERMENT PERMIT
(Must be presented to the Local Registrar of the Registration District in which the disinterment is to be made.)
I hereby request that a Disinterment – Reinterment Permit be issued to
(Name of funeral director or person acting as such)
whose full address is
,
,
(Street Name and Number)
(City or village)
(State)
to disinter and reinter or remove the body of
(Name of Deceased)
who died of
on the
day of
,
19
,
at
,
(City, Village, Township or Road District)
(State)
from the
Cemetery, at
,
County, Illinois
(Name of Cemetery)
(City, Village, Township or Road District)
to the
Cemetery (Crematory) at
,
(Name of Cemetery or crematory)
(City, Village, Township or Road District)
(State)
It is understood that this disinterment is to be made in conformity with the rules and regulations of the Illinois Department of Public Health and any local cemetery regulations.
(Signed)
Full address
,
,
Applicant's relationship to deceased
Date
TO BE FILLED IN BY LOCAL REGISTRAR:
Disinterment – Reinterment Permit Number
Date Issued
, 19
Local Registrar
Registration District Number
VR-207 (2/72r) This application is to be filed and preserved by registrar issuing permit.
(Source: Added at 15 Ill. Reg. 11706, effective August 1, 1991)