NSSAR - Patriot Grave Marking Program

Grave Registry
SAR Revolutionary Graves Committee
98Nov14 (based on REV 03/94 form)

This Form, and the Data on this form, are for Committee use Only.
To submit a registration electronically using this form:
(1) Follow the instructions to enter the requested information
(2) When form is complete click "Register" at the bottom of the form.

Note: You may print this page out, fill it in by hand and mail this form to:
Revolutionary War Graves Committee, NSSAR
1000 South Fourth St.,
Louisville, KY 40203

Providing Grave Registration Information

Type the information requested into the white areas below. Use the "tab" key to get to next block.

Patriot's Last (Family) Name (include all spellings):

Patriot's First Name (include all spellings):

Any Middle Name(s):

Prefix (e.g. Dr.): Suffix (e.g. Jr.):

Service to the Revolution:
Rank or Title:

State of Service:

Service(e.g., units, office, commanders, etc.) & Reference for Service:

Patriot's Pension No.:
Date of Birth: Year:(yyyy)Month:(mm)Date:(dd)
Place of Birth:
Date of Death: Year:(yyyy)Month:(mm)Date:(dd)
Place of Death:

Birth Name of Spouse [1]:
Widow[1]'s Pension No.:
Birth Name of Spouse [2]:
Widow[2]'s Pension No.:
Birth Name of Spouse [3]:
Widow[3]'s Pension No.:

Burial:
Name of Cemetery:
Location of Cemetery:(Town or Township):

Location of Cemetery:(County):

Location of Cemetery:(State):

Special Directions for Locating Cemetery and Grave site:

Tombstone? Yes No
If Yes, will Photographs to be sent? Yes No
{If yes, then:
To submit a photo of the headstone by mail, please include either a copy of this completed form or,
at a minimum, the Patriot's name, your name and the date this form was submitted, and mail to:

Revolutionary War Graves Committee, NSSAR
1000 South Fourth St.,
Louisville, KY 40203

or

To submit a digital photo (digital camera or scanned photo) of the headstone by email attachment:
1) Click the email link below to the Chairman;
2) Type into the text body of the email: the Patriot's name, your name and the date this form was submitted;
3) Click attach on your email, locate and select the photo file;
4) Email the attachment.
Click this link to send email attached photo to:
Chairman, Rev. War Graves Committee

Rev. War Service Marker? Yes No
If yes, what type? Old? VA? SAR? DAR?, other (give organization name)
Date marker was placed (if known):

Other Information / References to Printed Source of Information:

Information about the person submitting the information:

Name:

E-mail:

Street Address:

City: State: Zip Code:

Country:

Date this form was filled in:

Submitting the Form

Note: You may print a copy of the completed form for your records and a copy to accompany the submission
of photographs by going to [File] [Print] on your computer BEFORE you submit the form.
However, some versions of Netscape will not print forms properly.

Alternatively, a printable listing of your submission will appear after you send the form and the
information submitted may be printed at that time by going to [File] [Print] on your computer.

Now you may click on either
-- the "Register" button below to submit the data to SAR Revolutionary Graves Committee
-- the "Clear Form" to start over again.
Note: If you do not see two buttons marked "Register" and "Clear Form" immediately below this note,
then you cannot use this response form, and you should notify the Page manager.

SAR Grave Marking and Registry

SAR Marker

U.S. Marker

Ordering the

Graves Registry

Ordering the

SAR Marker

Tips on finding

a gravesite

WWW
www.sar.org

The National Society
of the
Sons of the
American Revolution

Contact NSSAR

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National Society Sons of the American Revolution
1000 South Fourth Street | Louisville, Kentucky 40203 | 502-589-1776