HISTORIC TEXAS CEMETERY REQUEST FOR DESIGNATION
List additional descriptions or information on separate pages, if necessary.
IDENTIFYING INFORMATION
Primary name: ______________________________
County:
Person completing this form:
Address:
City, State, ZIP:
Phone:
Fax:
Affiliation with cemetery:
LOCATION
Cemetery address, if known:
Optional: Latitude:
Also known as: _____________________________
Date:
Email:
Nearest city, town, or community):
Longitude:
Driving directions to cemetery from nearest town, include directions and distances:
TRUSTEESHIP OR CEMETERY ASSOCIATION
Is the cemetery
Public or
Private?
Name of individual, political entity, organization, or religious institution associated with cemetery:
Address, City, ZIP:
Association meeting dates, if applicable:
LAND SURVEY, SECTION, AND ABSTRACT (i.e., G. TEAGUE Survey, Section 12, Abst. 6140)
Original Survey Name and Abstract Number:
DEED REFERENCE
If known, provide deed information (volume, page, signing date) for deeds that specifically reference the
cemetery. For the purpose of the HTC designation, please provide copies. If you have looked for deed records
that mention the cemetery, but cannot find them, please write where you looked for these records.
STATE USE: Cemetery number:
USGS Map:
Feature
Yes  No
Endangerment:  L
M H
OWNERSHIP OF LAND ADJACENT TO CEMETERY
* This information is necessary for the HTC designation, as the owner of the property containing the cemetery
and adjacent property owners will be contacted by mail. Please list landowner(s) including the owner of the
property containing the cemetery, or adjacent landowners who share a common boundary with the cemetery. We
do not need information on landowners across a street. Please indicate the location of each property owner on
the Property Map. If there are more than four owners, please continue on a separate sheet of paper.
Owner No. 1:
Address, City, ZIP:
Owner No. 2:
Address, City, ZIP:
Owner No. 3:
Address, City, ZIP:
Owner No. 4:
Address, City, ZIP:
EXISTING HISTORICAL MARKERS AND GRAVE MARKERS
Provide title and date of each THC historical marker within the cemetery.
Provide title and date of nearby THC historical markers, if any:
SURROUNDING LAND USE (check all that apply)
Urban setting
Suburban setting
Rural setting
Industrial
Level
Sloped
Encroachment
Transitional
Other:
Game preserve
CEMETERY ACCESS (check all that apply)
Direct access to public road
Public access
Private property (you must have permission to access)
Limitations to access:
Primary access (Is this cemetery reached primarily by driving on roads or do you have to walk or hike to it?):
Walk
Drive
Distance from nearest road:
Name of road and distance (i.e., 200 yards north of CR 24)
IDENTIFIABLE CULTURAL HERITAGE (check all that apply)
African American
Asian
European
Hispanic
Jewish
Other:
Middle Eastern
Native American
Language on stones:
Other cultural information:
IDENTIFIABLE RELIGIOUS HERITAGE (check all that apply)
Catholic
Islamic
Jewish
Protestant
Other:
Source:
HTC Application August 2014, Pg 2 of 5
LANDSCAPING
Identify the following and note whether the plants are cultural (planted deliberately) or natural growth, if
known.
Cultural plantings (please include trees, shrubs, and ground cover)
Natural plants (please include trees, shrubs, and ground cover)
PERIMETER
Dimensions:
x
feet (Note: dimensions should match what appears on your Site Plan Map)
Acreage (Acreage may be found from the county appraisal district):
Partially fenced
Fully fenced
Vacant land
Body of water
No fence
Other:
Cultivated fields
PERIMETER FENCE (if applicable)
Barbed/woven wire
Brick
Cast/wrought iron
Trees
Hedgerow
Wood
Other:
Chain link
acres
Trimmed grass
Resin/synthetic
Irregular shape
Roads
Stone
AGE AND CONTEXT
Approximate number of graves:
Dates of burials: Oldest
Most recent
Is the cemetery still active?
Yes
No
Unmarked graves
Marked graves, no dates
Dated graves
Associated cultural context (such as
neighborhood, community, church, etc.) Name of church or associated context:
Original geographic context removed (small cemetery now in road right-of-way, parking lot, etc.)
Subsequent community established around cemetery site
Was the Cemetery relocated from original
site? If so, what is your source for this information?:
Burial records exist
Gravestones have been inventoried
Printed inventory available/location:
CEMETERY CONDITION
Evidence of cemetery above ground
Graves not readily visible
Grave depressions
Overgrown
No obvious evidence of maintenance
Select sections maintained
Trash/dumping ground
Tilted/leaning stones
Fallen stones
Missing features
Evidence of gravestone repairs
GRAVESTONE MATERIALS
Cast iron
Ceramic photographs
Granite
Limestone
Marble
Wood
Tile
Zinc
Other:
Maintained
Vandalized
Concrete
Fieldstone
Funeral company marker
Resin/plastic
Sandstone
Steel
Structural glass
HTC Application, August 2014 Pg 3 of 5
CEMETERY FEATURE OVERVIEW
Cemetery sign:
Yes
No
Location of sign?
at the cemetery
Text on sign:
on the road
on gate
on fence
on post
Entry gate:
Yes
No
Gate or arch manufacturer (if indicated):
Perimeter fence materials:
Barbed wire
Combination
Woven wire
Stone
Brick
Wood
Cast/wrought iron
Other:
Chain link
Fenced plots: These types of fences are usually found around either individual graves or grouped/family grave
plots; this does not refer to the fence around the entire cemetery, but only the smaller fenced plots:
Family fenced plots; number:
Individual fenced grave plot(s); number:
Fenced plots materials:
Barbed wire
Combination
Woven wire
Stone
Brick
Cast/wrought iron
Wood
Other:
Chain link
Curbing. Curbing is a low rim of building material that may be found around an individual plot or a larger
grouping of graves, such as a family plot:
Cut stone
Concrete
Brick
Other: _______________
Grave decoration:
Shells
Cemetery roads (drivable):
Other:
Walkways and paths:
Terracing/retaining walls:
Gravel
Scraped earth
Dirt
Dirt
Brick
Brick
Yes
Segregated burials:
Family
Race
Babies
Institutional
Other:
Gravel
Floral
Gravel
Paved
Paved
Other:
Cobblestone
Stone
Grass
Grass
Other:
No
Religion
Fraternal order
Nationality
Pauper
Cemetery features:
Benches
Flagpole
Folk decorations
Fountains
Grave houses
Grave shrines
Grave slabs
Handcrafted/local castings
Cairns
Mausoleums/vaults
Obelisks
Original statuary
Outhouse
Tabernacle
Structures or out buildings
Unique stone carving
Urns
Water Well or pump
Other:
Signed statuary; name:
Signed gravestones (referring to an artist or company who made the headstone); name:
VETERANS GRAVESTONES
American Revolution
War of 1812
Texas Revolution
Mexican War
Indian Wars
Spanish American War
World War I
World War II
Vietnam War
Gulf War
Afghanistan
Iraq
Other:
Civil War
Korean War
HTC Application August 2014, Pg 4 of 5
HISTORICAL BACKGROUND
Provide a brief history of the cemetery with bibliographic references. Use additional pages if needed.
Note: Previously, applicants were required to obtain a signature from the County Historical
Commission (CHC) Chair. This is no longer a requirement. Instead, personnel at the THC’s Cemetery
Program will notify the CHC of your application.
If sending electronically:
Send the application, photos, and supporting
documents as email attachments to:
jenny.mcwilliams@thc.state.tx.us
Be sure to include the cemetery name, county, and
“HTC application” in the Subject line.
If sending hard copies or disc:
Send the application, photos, supporting documents,
and application fee to:
History Programs Division
Texas Historical Commission
PO Box 12276
Austin, TX 78711-2276
Questions?
History Programs Division
Texas Historical Commission
PO Box 12276, Austin, TX 78711-2276
Phone: 512.463.5853; Fax: 512.475.3122
Email: history@thc.state.tx.us
The Historic Texas Cemetery designation policies are
adopted as Commission rules in the Texas
Administrative Code, Title 13, Chapter 22,
Section 22.6.
HTC Application August 2014, Pg 5 of 5