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DocuSign Envelope ID: 2D970A62 -10C1- 4949 - 9224- E9F2ADB7D568 <br />Mil <br />North Carolina Cemetery Site Form <br />Identity <br />Cemetery name(s) <br />State site number: 31 <br />Other site numbers <br />Recorded by_ <br />Mailing address <br />Phone number(s) <br />Form submitted by <br />Reason for recording cemetery <br />If compliance, provide: <br />Tracking number <br />Compliance project name <br />Location and Ownership <br />County <br />Cemetery address (if applicable) <br />Directions to cemetery: <br />State Property Office complex number <br />(CTY) (CO) (COMP <br />Organization assigning other number <br />Organization name (if any) <br />Email <br />Date Submitted <br />City, town, community or township <br />Access to cemetery: Restricted (explain) <br />Unrestricted <br />Cemetery owner name and address: <br />USGS topographic quadrangle map name <br />Provide coordinates in Latitude * ' <br />OR Universal Transverse Mercator (UTM) <br />Datum: NAD27 Zone _ Easting <br />NAD83 <br />Longitude <br />Northing <br />** *Please attach a map showing the cemetery's location * ** <br />1 <br />