New Jersey Society of the War of 1812

                                                   Grave Registration

1.  Veteran’s last name ____________________first____________middle____________

2.  Birthdate: mo._________ day_______ yr._______. Place______________________

3.  Deathdate: mo.________ day_______  yr._______  Place______________________

4.  Cemetery name: _________________________________________                  

    Cemetery address_____________________________                County___________

          Cemetery phone no. _____________ Contact:_____________________________

          Grave location _________________________Long:_____________Lat:_______

5.  Headstone/monument: Y/N  -description & condition ___________________________

____________________________________________________________________

6.  Marker: Y/N – description _____________________________________________

7.  Comments concerning condition of gravesite: _________________________________

8.  Photo: provide a photo of cemetery entrance and gravesite: Y/N

9.  Veteran’s service: branch _______________________________________________

Unit designation: _____________________________________________________

Other: ____________________________________________________________

    Rank: _____________

10. Relatives: (name them & provide known info): Spouse___________________________

11. Grave location: Please provide directions to the cemetery, vehicle parking facilities and accessibility to gravesite:

12. Provide information that will help decide whether to place an 1812 marker at this site.

Your name:___________________________________Date______________________

Address: ____________________________________           Phone________________

Use reverse for any info that cannot be placed on this sheet.    

Submit to: R. J. Fenner, 130 Lowell Drive, Marlton, NJ 08053                                      5/05(2)