Cemetery Information Form
Print, fill out, then mail to: Betty Stewart, 6009 Natick Court,
Burke, Virginia 22015-2930
Cemetery Information: Date___/___/___
Name (if any)_____________________________________________________________________
Location / Nearest Town__________________ County_____________ State_____ Zip
________
(Address or directions)_____________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
(If address is not exact, give nearest major road, a cross-street or other major
landmark, and the distance and compass direction (N, NE, NW) of the cemetery
from that point. Please note if distance and direction are measured or estimated.
Continue on attached page if necessary.)
Property Type: Church___ Public___ Funeral Home___ Private___
If private, still in family? ____
Property Owner: __________________________________________
Friendly to visitors?_______
Address_____________________________________________________
Phone_______________
Graves: Section and plot if applicable:_______________
Number of graves this location_______
In the spaces below, please enter "unknown" or "none" for
any data not on the stone, For "Marker", enter the composition (brass,
granite, slate, etc.) and the style(if known). Please put dates only if read from
the stone. You may attach actual inscription text and stone style information
on a separate page, if you have it. PICTURES ARE WELCOME, BUT PLEASE TRANSCRIBE
THE INSCRIPTION ON A PIECE OF PAPER!!
(Name) (date) (date) (stone)
1.____________________________________ b __________ d _________ _________________
2.____________________________________ b __________ d _________ _________________
3.____________________________________ b __________ d _________ _________________
4.____________________________________ b __________ d _________ _________________
5.____________________________________ b __________ d _________ _________________
6.____________________________________ b __________ d _________ _________________
7.____________________________________ b __________ d _________ _________________
8.____________________________________ b __________ d _________ _________________
9.____________________________________ b __________ d _________ _________________
10.___________________________________ b __________ d _________ _________________
(continue on another page if necessary)
If possible, attach a survey(graph) of the cemetery plots as they exist in relation
to each other and to the cemetery in general (if part of a larger one) using the
same numbers as on the list above.
Relationships
Attach (1) a chart or other document describing the relationships of these people
to each other and/or yourself, if known. (2) descent of each person (by number)
from the earliest known Strother ancestor, if a descendent. Example: 1. William(imm.1650),
Robert, Enoch, James, John, George, Annie m. E.K. Phillips, Ann m. C.D.Toney,
Nancy m1. M.L.Morgan m2. A G Upshaw)
Contributor Information:
Name_____________________________________ Phone (_____) ______________ (day)
Address___________________________________ Phone (_____) ______________ (eve)
_________________________________________ EMAIL:________________________________
Zip:__________