Printable Headstone Photo Request Form

We have now made it possible for you to order a photo of a Loved One, Family Member, or Friends headstone. There is a small fee for this service which will help maintain the on going cost of this website.

The fees for this service are as follows:

• 1 photo for $ 10.00
• 3 photos for $ 25.00

Please print this form and send it with your check or money order payable to:

Thomas E Burger
P.O. Box 745
Hilton, NY 14468

Once we receive your payment we will be able to send the photos to either your home mailing address or in digital format to your E-mail address which ever you prefer.

Note: If more then one name is ordered please print a copy of this form for each name that you order.

Please supply the following information:

If you know the following:

• Grave location: ____________
• Lot location: ______________
• Section:  _________________
• Division:   ________________
• Year of death: _____________

With cemetery records we can locate the headstone with out any of the above information; however we will have to make sure you supply the full name of the deceased to do this.Please state if photo's are to be sent to:

___ Home Address  or  ___ E-mail

Name _______________________________________________________

Address _____________________________________________________

City ____________________________ State _______ Zip _____________

E-mail _______________________________________________________