Purpose:
This worksheet is a tool to collect data on individuals interred in the Rutland Cemetery. It is anticipated that the majority of the worksheets will be completed by descendants or extended family members. The worksheets will be used by the Cemetery Committee of the Rutland Center Church & Cemetery Committee to update and expand its cemetery records.

Instructions:
1) Complete one worksheet for each person. Additional copies can be made of this form.
2) Use maiden names for females.

Surname:__________________________________________________________

First/middle name: __________________________________________________

Date of birth: _______________________________________________________

Place of birth: ______________________________________________________

Name of mother (use maiden name): ___________________________________

Name of father: _____________________________________________________

Name of spouse: _____________________________________________________

Date of marriage: ____________________________________________________

Place of marriage: ___________________________________________________

Place of residence (city/town/township/state): ______________________________

Date of death: _______________________________________________________

Place of death: ______________________________________________________

Buried at Rutland Cemetery: yes_____ no_____

Completed by (name, address, phone, email): ______________________________
   __________________________________________________________________
   __________________________________________________________________

Names, addressess, phone and/or email addresses of other living descendants or informed people:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

Do you have family records that you would be willing to share (death certificate, obituary, published family history)? yes _______ no ____________

Comments:_________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

I give permission for the Rutland Center Church & Cemetery Committee to use the data given on this worksheet to update their cemetery records. I understand that this information may be published at some time.

Name: _______________________________________________________
Date: ________________________________________________________

I give permission for my name, address and/or email address to be given to individuuals who want to contact me to discuss the information given on this worksheet. It is anticipated that descendants may want to communicate by mail or email with other descendants.