North Carolina Cemetery Survey


 1. Location
    a. Names(s) of cemetery _________________________________________                     
    b. County ______________
    c. City, town, community, or township ___________________________
    d. Specific location ____________________________________________
       ______________________________________________________________
       ______________________________________________________________
    e. Property owned by ____________________________________________
    f. U.S.G.S. Topographic Map: Quandrangle ________________________
       1. Cemetery coordinates: Latitude ______ Longitude ______
       2. Cemetery number on map ______

 2. Classification
    a. Public ___ Municipal ___ County ___ State ___ Federal ___
    b. Private ___ Family ___ Church ___ Denomination _______________
    c. Abandoned ___ Maintained, but not used ___ Currently used ___
    d. Approximate number of graves ___ Approximate size cemetery ___
    e. Native American ___ African American ___ Slave ___ White ___
       Other ___ explain _____________________________________________

 3. Accessibility to Public
    a. Unrestricted ___ b. Restricted ___ explain ____________________

 4. Condition
    a. Well maintained & preserved ___ b. Poorly maintained ___
    c. Overgrown but easily identifiable ___
    d. Overgrown and not easily identifiable ___
    e. Not identifiable as a burial site, but known to exist through 
       tradition or other means. Explain _____________________________
       _______________________________________________________________
       _______________________________________________________________

 5. Cemetery Enclosure
    a. Is the cemetery enclosed by a wall, fence, hedge, etc? ___ 
       If yes, specify how it is enclosed ____________________________
    b. State condition of wall, fence, hedge, etc ____________________
 
 6. Tombstone or Markers
    a. Are stones or markers present? ___ 
    b. If yes, are they inscribed? ___
    c. Number of readable stones or markers ___ 
    d. Date of last known burial ___
    e. Date of earliest known burial ___ 
    f. Are there unusual stones? ___ If so, describe them ____________
       _______________________________________________________________
       _______________________________________________________________
    g. Have markers been damaged? ___ If yes, by farm animals? ___ 
       Vandalism? ___ Farming operations? ___ Construction? ___
       Industrial operations? ___ Custodial care? ___ Other means? ___ 
       Explain ________________________________________________________
       ________________________________________________________________
       ________________________________________________________________

 7. Note any hazards imperiling the cemetery's existence ______________
    ___________________________________________________________________

 8. Has this cemetery been listed in an existing published or unpublished
    cemetery survey? ___ If yes, explain ______________________________
    ___________________________________________________________________

 9. Historical or other special significance of cemetery ______________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________

10. Any other information pertinent to the cemetery ___________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________

11. Please attach a list of individuals buried here, with any inscriptions
    on tombstones, to this form.


Submitted by ____________________________________ Date ________________

Organization __________________________________________________________

Address _______________________________________________________________

Email address ______________________________ Telephone ________________

This form has been prepared for use by the North Carolina Cemetery Survey
Project. Inquiries concerning the study should be addressed to North 
Carolina Cemetery Survey Project, North Carolina Division of Archives and
History, 4614 Mail Service Center, Raleigh, North Carolina 27699-4614