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United Daughters of the Confederacy®
Records of Interments of Confederate Veterans Committee

       
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Copyrighted Records of Interments of Confederate Veterans Committee UDC, all rights reserved.
NAME AS IT APPEARS ON GRAVE MARKER


Last name:
First and Middle name:

ALTERNATE NAME


Last name:
First and Middle name:

MILITARY SERVICE


Rank: Company: Regiment: ServiceState:

Type:

Infantry:
Cavalry:
Artillery:
Engineers:
Generals & Staff:
CSN:
CSMC:
Other:
If Other, explain:
Civilian:
If Civilian, explain:

Reference Source:
Date of Birth:
Place of Birth:
Date of Death:

Additional information

CEMETERY INFORMATION


Cemetery Name:
Cemetery Manager:
Cemetery Address:

Cemetery County: 
Cemetery Location (if address unknown):
Cemetery Telephone (use (XXX)XXX-XXXX format):
Is there a gravestone?: Yes
Is Confederate service listed?: Yes
Is it a memorial marker (no remains)?: Yes
Is there an Iron or Brass Cross?: Yes
If Iron or Brass Cross, who placed it?:
If no gravestone, describe location of grave:

SUBMITTER


Name of submitter:
Submitter Telephone (use (XXX)XXX-XXXX format):
Submitter e-mail:
Submitter Chapter Name:
Submitter Chapter Number:
Submitter Chapter City:
Submitter Chapter Divison/State:

Date Form Submitted: