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