Cemetery marker report for

___________________________
Name

Cemetery Name:

Location: (town or area, county, state)

Other Location Notes:

Grave Section, Row, Number, if known:

Other grave location note:

Marker: present or missing:

Direction marker faces: N__ S__ E__ W__ NE__ NW__ SE__ SW__
Other (describe):

Marker type: Head__ Foot__ Table__ Tomb__ Mausoleum__
Combined__ Family__Other (describe):

Marker Material: Wood__ Stone__ Bronze___ Other (describe):

Marker Condition: Intact__ Chipped__ Cracked__ Crumbled__ Eroded__
Broken__ Tilted__ Sunken__
Insert, decorative element, panel fallen/broken/missing___
Discolored/stained moss/lichen/other:______

Marker Condition notes:

Marker Design: flat-rectangle__ flat-curved__ top-flat__carved sides or top__
other carving or decoration__

Marker Design notes:

Condition of inscription: Mint__ Clear but worn__ Mostly decipherable__
Traces decipherable__ Illegible or destroyed__ Underground__

Inscription (use one line per line on the marker):

Additional notes: