Illinois Administrative Code (Last Updated: March 27, 2024) |
TITLE77. PUBLIC HEALTH |
PART500. ILLINOIS VITAL RECORDS CODE |
§500.APPENDIX I. Subregistrar's Appointment Blank
-
SUBREGISTRAR'S APPOINTMENT BLANK
I,
, Local Registrar of Registration District
No.
County, Illinois, hereby request the State Registrar
of Vital Records to approve my appointment of the individual listed below as Subregistrar of Subregis-
tration District No.
, effective
,19
.
Miss
Mrs.
Mr.
(Name of Subregistrar)
(Local Title, if any, i.e., City Clerk)
Subregistration Office Address
, Illinois
(Zip Code)
Telephone Numbers: Office
Residence
Area Code
The area in which I authorize this Subregistrar to serve is:
Anywhere within my Local Registration District.
Restricted to these areas:
Signed:
, Local Registrar
Address:
Dated:
, 19
, Illinois
(Zip Code)
APPROVED this
day of
, 19
, M.D.
Director, Illinois Department of Public Health; and
State Registrar of Vital Records, Springfield, Illinois
NOTE:
Local Registrar should fill in and submit this form in triplicate to the Office of Vital Records, Illinois Department of Public Health, Springfield, Illinois, 62761. If the appointment is approved, the Department will retain one copy and return two to the Local Registrar, one for his files and one for the Subregistrar. An engraved certificate will also be sent the Local Registrar to present to the Subregistrar.
VR 303 (2/75)
(Source: Added at 15 Ill. Reg. 11706, effective August 1, 1991)