Name____________________________

Date_____________________________

Name of Cemetery______________________________________

CAREFULLY COMPLETE THE FOLLOWING INFORMATION:
Full name of the deceased: _________________________________________

Date of Birth (month/day/year): _______________________________________

Date of Death (month/day/year): ______________________________________

Age at death (years/months/days): ____________________________________

Husband/Wife of: _________________________________________________

Son/Daughter of: _________________________________________________

Other information about the deceased revealed on the stone:

Copy the inscription (information or data about the deceased) and epitaph (short poem, saying, or other message) precisely as they appear on the stone (Be sure to copy the style of engraving carefully, attending to details such as upper and lower case, abbreviations and/or archaic spellings, relative size and style of font):

Sketch the gravestone's shape, decorative carvings and designs:

Describe any unusual or interesting features of the stone:

If appropriate, draw the unusual features: