Cemetery Records Worksheet
Mason County, WV

Are You                  

 Public Official
 Clergy
 Cemetery Owner
 Cemetery Manager
 Administrator
Interested Individual
Tell us how to contact you if we need more information
    
Name
E-mail
Work Phone
Cell Phone
Home Phone
FAX
Address 1 
Address 2
City
State
Zip

Tell us about the cemetery you would like recorded
           Please provide any and all information available to you. 
If you don't know the answer to some of the questions - just leave them blank. 
We will be collecting information from many sources. 
By merging all of this information into a single source - 
it will be available for future historical research.

The Name (or Names) the Cemetery is known by
County
City, Community or Township located in
Managed or Owned By
If Private - Located on who's property
USGS Topographic Map Quadrangle
Cemetery Coordinates

 Latitude      

 Longitude   
Classification

   Status

      Size- Number of plots
    Type
Explain - Elaborate as necessary 
Accessibility to Public
Explain - Elaborate as necessary
Condition
Explain - Elaborate as necessary

Enclosure   

Condition
Tombstones or Markers Are stones or markers present? YES NO
Are a Majority inscribed? YES NO
Number of readable markers
Date of last known burial
Date of earliest known burial
Describe any unique or unusual markers
Are markers damaged? 
Damage caused by - 
Is there a written record available listing any or all of the burials in this cemetery? YES

If YES, where can the 
survey project obtain a copy?
NO
Describe any hazards imperiling the cemeteries existence
Has this cemetery been listed in any existing published or unpublished cemetery survey? If yes, name the publication and describe where it might be available.
Describe any historical or other significance of this cemetery
Any additional information not included above
 

I certify that the above information is accurate and correct to the best of my knowledge
Name of Information Provider

 Since all information provided will ultimately be entered into a computer database, we prefer that your data be submitted electronically. If you are unable to convert your data to electronic form, please submit copies to:
Mason County Cemetery Survey
305 Main Street 
Point Pleasant, WV 25550

If you have original documents that you cannot copy, please contact the 
Mason County Cemetery Survey Project at:
cemetery@masoncounty.org 
for additional instructions.

This information will be used to record the information about the cemetery in an 
information database. When completed, this data will be available to anyone seeking 
information about cemeteries and burials in Mason County.

Thank you for your time and interest in this study.