Goshen Township Burial Report
Cemetery:	Bunker Hill	East Goshen OLD	East Goshen NEW	Lumberton
Lot Number:	_________________	Grave Site:	_________________
Name of Deceased:		_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
		First	Middle	Last
Maiden Name, if any:	_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _		Male / Female:	_ _ _ _ _ _ _ _ _ _ _ _
Date of Birth:	_ _ _ _ _ _ _ _ _ _ _ _	Date of Death:	_ _ _ _ _ _ _ _ _ _ _ _
	(mm / dd / yyyy)		(mm / dd / yyyy)
Date of Burial:	_ _ _ _ _ _ _ _ _ _ _ _	Funeral Home:	_ _ _ _ _ _ _ _ _ _ _ _	_ _ _ _ _ _ _ _ _ _ _ _
	(mm / dd / yyyy)
Veteran:	Yes                    No	Which war:	_ _ _ _ _ _ _ _ _ _ _ _
Cause of Death:		_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Place of Death:		_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Mail to:	Goshen Twp. Cemetery Records
	14003 W. South Range Rd.
	Salem, OH  44460-9127