FORMS

Authorization for Release

(The Authorization for Release Form is completed by the legal next of kin and provided to a hospital, coroner's office, medical examiner, or nursing home to give your permission for Hultgren Funeral Home to pick up your loved one from the place of death and to bring them into our care. Many facilities will not allow the funeral home to move forward without this document.)

Death Certificate Worksheet Form

(The Death Certificate Worksheet can be filled out to provide Hultgren Funeral Home with most of the information needed for the death certificate.)

Cremation Authorization

(The Cremation Authorization is a legal document that must be signed by the next of kin in order to move forward with cremation.)

State of Illinois Department of Human Services Public Aid Reimbursement

This form is used to reimburse the person who has assumed full responsibility for the funeral and burial expense of a deceased

Illinois Department of Human Services recipient. When two or more persons have been party to the arrangements, one must be

designated to file the claim for reimbursement since only one claim will be accepted. 

Return form to:

IDHS Funeral and Burial

100 South Grand Ave East, Second Floor

Springfield, IL 62762

Email; dhs.fb@illinois.gov

Fax 217-524-7554