Purpose:
This worksheet is a tool to collect date 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) Print out and complete one worksheet for each person.
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:

City, State, Zip:

Email:

Names, addresses, phone an/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)?

Comments: ___________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

I give permission for the Rutland Center Church and 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.

Signature: ___________________________________________________________________

Date: _______________________________________________________________________

I give permission for my name, address and/or email address to be given to individuals 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.

Return to: Jennifer Eager Ehle
11245 N. State Rd. 138
Evansville, WI 53536-8925
stevee@inwave.com

JEE 8/03