Lonely grave notification

1. Location. Nearest town, railway siding or station homestead:
Distance in kilometres from this place: Approximate direction from the above place: ? North North NE North East East NE East East SE South East South SE South South SW South West West SW West West NW North West North NW

Give specific location: Hundred of Section no

Describe precise location [eg 100 metres from road intersection 10 m into field]
           

2. Details about the persons buried

First person: Full name: (If name not known enter Unknown)
Person buried alone? Unknown Yes No
Buried with:

Date of death: Cause of death: Age at death:

Any other information known:

Second person: Full name:
Person buried alone? Unknown Yes No
Buried with:

Date of death: Cause of death: Age at death:

Any other information known:

Third person: Full name:
Person buried alone? Unknown Yes No
Buried with:

Date of death: Cause of death: Age at

Any other information known:

3. Grave details If a headstones exists please record the wording. Please record the text as it appears on the stone line by line. Use _ for illegible text [eg 2_ March]
           
Record other grave furniture present: [eg iron railing, stone outline, wooden rails etc.
           
Any photographs or good quality photocopies of photographs would be most welcome.
o Photograph/s available on request Yes No
o Photograph/s posted, please return after copying. (please pack to prevent damage. Yes No
o Photograph/s posted, please keep. Yes No
If you have a scanner you can send photos as an email attachment. Please advise first.
o Photograph/s available

4. Your contact details
Your name:

Address: (Optional)

Email: