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Use to provide data concerning the creation or disposition of temporary cemeteries. Reference: FM 10-286 and FM 10-297.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — NAME_______________________________________(Name or Title of Cemetery)

LINE 4 — OPENED_____________________________________(DTG Cemetery Opened)

LINE 5 — COORDINATES_______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator)

LINE 6 — TOWN NAME_________________________________(Name of the Town, Village, or City Nearest the Cemetery)

LINE 7 — ROAD NUMBER_______________________________(Cemetery Access Road Number)

LINE 8 — ROAD NAME_________________________________(Name of Access Road to Cemetery Site)

LINE 9 — CAPACITY___________________________________(Total Capacity of Cemetery)

LINE 10 — REMAINING CAPACITY_______________________(Unused Capacity of the Cemetery)

LINE 11 — DISTANCE__________________________________(Distance in Feet Between Grave Reference: Marks)

LINE 12 — WIDTH______________________________________(Width in Feet of the Cemetery Access Road)

LINE 13 — SECURITY TYPE_____________________________(Security Type Provided at the Cemetery)

**Repeat lines 3 through 13 to report data on multiple temporary cemeteries. Assign sequential line numbers to succeeding iterations; for example, first iteration, 3 through 13; second iteration, 3a through 13a; third iteration, 3b through 13b; and so on.

LINE 14 — CEMETERY NAME ___________________________(Name or Title of the Cemetery That Was Closed)

LINE 15 — COORDINATES______________________________(Coordinates of the Cemetery as Closed)

a. _________________________________

b. _________________________________

c. _________________________________

d. _________________________________

LINE 16 — DATE CLOSED_______________________________(DTG Cemetery Was Closed)

LINE 17 — QUANTITY BY CATEGORY____________________(Quantity of Remains by Personnel Category at the Cemetery That Was Closed)

**Repeat lines 14 through 17 to indicate the closing of multiple temporary cemeteries. Assign sequential line numbers to succeeding iterations; for example, first iteration 14 through 17; second iteration 14a through 17a; third iteration 14b through 17b; and so on.

LINE 18 — NAME______________________________________(Name of Cemetery That Was Cleared)

LINE 19 — LOCATION__________________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator) of the Cemetery Cleared)

LINE 20 — DATE CLEARED _____________________________(DTG Cemetery Was Cleared)

LINE 21 — LAND CONDITION___________________________(Enter RESTORED or NOT RESTORED)

**Repeat lines 18 through 21 to indicate the clearing of multiple temporary cemeteries. Assign sequential line numbers to succeeding iterations; for example, first iteration 18 through 21; second iteration 18a through 21a; third iteration 18b through 21b; and so on.

LINE 22 — ON HAND___________________________________(Count of Remains on Hand at Beginning of Report Period)

LINE 23 — RECEIVED___________________________________(Count of Remains Received During Period)

LINE 24 — TRANSFERRED_______________________________(Count of Remains Transferred During Period)

LINE 25 — AWAITING TRANSFER________________________(Count of Remains Awaiting Transfer at End of Period)

LINE 26 — BURIED_____________________________________(Count of Remains Buried During Period, if Applicable)

LINE 27 — AWAITING BURIAL __________________________(Count of Remains Awaiting Burial at End of Period, if Applicable)

**Repeat lines 22 through 27 to indicate multiple reports of remains transferred and buried. Assign sequential line numbers to succeeding iterations; for example, first iteration 22 through 27; second iteration 22a through 27a; third iteration 22b through 27b; and so on.

LINE 28 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report

LINE 29 — AUTHENTICATION___________________________(Report Authentication)

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