Cemetery Information

Cemetery Name
Please give us the current or most common name of the cemetery that you are reporting on. If the name unknown, the most common surname found in the cemetery can be used as a name. You may also use a road or community name if applicable. Please, if at all possible DO NOT submit the name as "Unknown" or "Unsure". 

Other Names
Please give us any other known current or previous names  of the cemetery that you are reporting on. 
Please DO NOT submit the name as "Abandoned", "Unknown" or "Unsure" in this category. 

Is the cemetery marked by a identifying sign or marker?
Yes
No

Street Address
If the cemetery resides on private property, such as a farm or business, please give us that address.  In the event that there is not a street address assigned to the property that the cemetery is located on, please give us the name of the nearest street or road, or the route number.

City or Town
In the event that the cemetery is not located within the borders of a town or city, please list the nearest one, and approximately how far away it is from that location. 

Township

County / Parish

Province/State

Nation

Zip or Postal Code

GPS Coordinates

Latitude  (N/S HDDD MM.MM)* (WGS84 datum)	N S
Longitude (W/E HDDD MM.MM)* (WGS84 datum)	W E

Current cemetery status could be best described as:
Active
Inactive
Abandoned
An “abandoned cemetery” is defined as “a cemetery that has not had burials within the past 25 years and which shows signs of neglect including, without limitation, the unchecked growth of vegetation, repeated and unchecked acts of vandalism, or the disintegration of grave markers or boundaries and for which no person can be found who is legally responsible and financially capable of the upkeep of such cemetery.”

Approximate overall physical size of cemetery:
Small
Medium
Large

Directions from nearest Community
Please indicate County Road Numbers, key landmarks, signage, distance from nearest road, etc.

The road that is nearest to the cemetery is:
A public road
A private road

Cemetery Description
Location, Access, Security

Location

The area surrounding the cemetery is best described as:
Urban 
Suburban 
Rural 

The terrain that the cemetery is located on would best be described as:
Level
Hillside

Does the cemetery either border or contain within it's boundaries a water source? 
Such as a stream, river, lake or pond.
Yes
No

Other natural features within cemetery:
Such as landscaping - trees, etc.

Access

This cemetery is located on what type of land?
Private
Public

Access to the cemetery is:
Open to all
Open with permission only
Inaccessible

Security

The cemetery is surrounded by:
A continuous masonry or other type wall
A broken masonry or other type wall
A continuous fence
A broken fence
No wall or fence
A hedge or row of trees or bushes

The cemetery has:
A gate that locks
A gate that does not lock
No gate

History of Cemetery

Date Cemetery Established
Please give us the date that the cemetery was first established. This may not necessarily be the date of the first recorded burial.

Approximate number of gravestones in cemetery:
Please include all known burials, both marked and unmarked in this cemetery.

Date of first internment:
From stone or records, enter the date of the FIRST known burial in this cemetery.

Date of last internment:
From stone or records, enter the date of the MOST RECENT known burial in this cemetery.

Have gravestones been removed from the cemetery?
Yes
No
Unknown

Are this cemetery ever been relocated?
Yes
No
Unsure

Are there indications of previous repair / restoration efforts?
Yes
No
Unsure

If yes, what repair methods were used?
Adhesives
Coatings
Iron pins / bolts
Metal supports
Other

Are there planned or ongoing previous repair / restoration efforts?
Yes
No
Unsure

Is there a currently existing cemetery association for this cemetery?
Yes
No
Unsure

Do cemetery or association burial records exist?
Yes
No
Unsure

Has this cemetery been inventoried by a Federal, state, county, or local historical group?
Yes
No
Unsure

If yes to either of the above two questions, please list (if known) the title, author, publishing date, location and availability of records or inventory. 
Due to the ever changing nature of the Internet please DO NOT list online inventories.

Design Characteristics of Cemetery

Landscaping

Does this cemetery contain any of the following:

Traditional Landscaping	Yes No Unsure
Natural paths	Yes No Unsure
Exceptional trees	Yes No Unsure

Structures

Does this cemetery contain any of the following architectural features:

Crypts or mausoleums	Yes No Unsure
Ornamental fencing	Yes No Unsure
Brickwork	Yes No Unsure
Decorative ironwork	Yes No Unsure
Sculpture	Yes No Unsure
Fountains	Yes No Unsure
Roads	Yes No Unsure
Buildings	Yes No Unsure

Markers

Materials of which markers are made from:

Cement	Yes No Unsure
Stone - Granite	Yes No Unsure
Stone - Marble	Yes No Unsure
Stone - Native	Yes No Unsure
Stone - Slate	Yes No Unsure
Stone - Other	Yes No Unsure
Wood	Yes No Unsure
Other Materials	Yes No Unsure

Decorative carvings and Scriptural forms found on markers :

Architectural forms	Yes No Unsure
Angels	Yes No Unsure
Draperies	Yes No Unsure
Fraternal Symbols	Yes No Unsure
Hands	Yes No Unsure
Lambs	Yes No Unsure
Monograms	Yes No Unsure
Plant or flower symbols	Yes No Unsure
Photographic Images	Yes No Unsure
Religious symbol	Yes No Unsure
Scrollwork	Yes No Unsure
Urns	Yes No Unsure
Other Carvings	Yes No Unsure

General Condition of the Cemetery 
Please describe the conditions in this cemetery that you have observed:

Overall Status
Please choose only the one that best describes the overall conditions currently found within this cemetery. A cemetery SHOULD NOT be listed as "Destroyed" unless there is little or no physical evidence remaining that a cemetery existed at one time in this location.

Cemetery poorly maintained Cemetery neglected Cemetery vandalized Cemetery in danger of destruction Cemetery destroyed

Is there the appearance of unmarked graves?
Yes
No
Unsure

Are there broken gravestones within the cemetery?
Yes
No

Are there toppled gravestones within the cemetery?
Yes
No

Are there disintegrating gravestones within the cemetery?
Yes
No

Are there indications of buried gravestones?
Yes
No
Unsure

Is weather erosion a problem in this cemetery?
Yes
No
Unknown

Is their evidence that pollution is a problem in this cemetery?
Yes
No
Unknown

Has this cemetery has been vandalized:
(stones overturned, broken or stolen; graffiti painted on walls or stones, etc.; graves desecrated)
Yes
No 

*******************

If you answered  "No" to the above question, please skip the next two questions

If yes, was a Police report filed?
Yes
No

Please indicate the problems fond in this cemetery as a result:
Overturned Gravestones
Broken Gravestones
Stolen  Gravestones
Graffiti
Graves Desecrated

********************

Vegetation Overgrowth

Vegetation overgrowth in the cemetery is:
Not a problem
A seasonal problem, preventing access
A constant problem, disturbing graves
A constant problem, disturbing stones
A constant problem, damaging stones

Please indicate the types of vegetation overgrowth problems found in the cemetery:
Trees
Ground cover
Moss
Vines

Water Drainage

Water drainage at the cemetery is:
Good all year round (not a problem)
A seasonal problem
A constant problem

Other General Problem's
Please choose all that apply

Encroachment without set back
Civil authority apathy to the situation

Current use of Cemetery site
Please describe how this cemetery is currently used that you have observed:

The present owner of the cemetery property is:
Association
City, town or village
Township
County
Regional government (State, Province, etc)
Federal or national government
Religious (Church, Synagogue, etc)
Lodge or Fraternal Order
Family
Private individual (s)
Business or corporation
Unknown

The cemetery property is currently used for:
Cemetery 
Agricultural use (crops or animal grazing)
Recreational use (park, playground, sports field)
Industrial use
Commercial use
Storage
Waste dumping
Residential use
Parking lot

Properties adjacent to cemetery are:
Recreational
Commercial 
Industrial
Woods
Agricultural
Residential
Transportation (Highway, Railroad, Airport, etc)
Educational
Religious

Compared to 1960, the cemetery boundaries enclose:
The same area
A larger area
A smaller area
Unknown

  If the boundaries are smaller, they have been reduced as a result of:
New roads or highways
Housing development
Commercial development 
Industrial development
Agriculture
Educational development
Religious development
Parking

The cemetery is visited:
Frequently
Occasionally
Rarely
Unknown

Has archeology been conducted at this cemetery?
Yes
No
Unknown

Does this cemetery provide a habitat for native birds and other wildlife?
Yes
No
Unknown

Surnames
Please list in alphabetical order all known surnames found in this cemetery.

Other Information or Comments
Is there anything else that you would like us to know about the condition of this cemetery? 
Please use this space to add any other pertinent information concerning this cemetery, 
including unique features not covered above, or  unique gravestone types or carvings.

Contacts

Previous Contacts:
Who have you previously contacted regarding this situation?
Please do not include this report.

Support Contacts:
Please indicate to others who they might contact to add their support to the cause.  For example, the Chairman of the Board of Supervisors or the County Planning Director. Where possible please give the persons full name along with their position. Please be sure to provide contact information. If you do not have email addresses for these contacts, please be sure to include a full mailing address.

Submitted By
In order for the report to be processed you MUST have your name 
and email address. 
This information is used for others to contact you concerning the situation that you are 
reporting and is required.
Failure to include this information will result in the rejection of the report. 

Your Name - Required
Please give both FIRST and LAST name.

Your Email Address - Required
You MUST include a valid email address.

Date of Submission

Photographs

If you have photographs of this cemetery and would like to submit them for 
use with this report please 
visit the Cemetery Photos page.