CEMETERY RECORD

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Surname

____________________________		______________________________
First and Middle Name		First and Middle Name
____________________________		______________________________
Birth Date		Birth Date
____________________________		______________________________
Death Date		Death Date
____________________________		______________________________
Marriage Date		Military Information
Epitaph:_______________________________________________________
___________________________________________________________
Cemetery Name (also show previous names):__________________________________
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Highway:_______	City:___________________	County: __________	State:______
Lot:___________	Section:_________________	Road:____________	Cemetery Book Code:______
Nearest Landmark:__________________________________________________
Other Information: __________________________________________________
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