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Use to provide data required to request establishment of a temporary cemetery and special burial procedures/ceremonies. Reference: FM 10-296.

LINE 1 — DATE AND TIME______________________________(DTG)

LINE 2 — UNIT________________________________________(Unit Making Report)

LINE 3 — REQUESTING AGENCY________________________(Identification of the Component/ Unit Making the Request)

LINE 4 — COORDINATES_______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of the Requesting Unit)

LINE 5 — SITE JUSTIFICATION__________________________(Reason a Temporary Burial Site is Necessary)

LINE 6 — FEATURE ____________________________________(Prominent Terrain Feature of the Proposed Site)

LINE 7 — COORDINATES_______________________________(UTM or Six-Digit Grid Coordinate With MGRS Grid Zone Designator of the Area Containing the Features Listed in the Preceding Line)

LINE 8 — NAME_______________________________________(Cemetery Name or Title)

LINE 9 — GRADIENT___________________________________(Relative Terrain Gradient (GENTLY ROLLING, MODERATE, STEEP, or VERY STEEP)

LINE 10 — DRAINAGE__________________________________(Type of Drainage (NATURAL, MAN-MADE, or NONE)

LINE 11 — SOIL _______________________________________(Type of Soil)

LINE 12 — LAND USE __________________________________(Current Use of the Land)

LINE 13 — ROAD NUMBER______________________________(Access Road Number)

LINE 14 — ROAD NAME ________________________________(Name of Access Road to Cemetery Site)

LINE 15 — ROAD SURFACE _____________________________(Type of Surface on Access Road)

LINE 16 — VEGETATION________________________________(Type of Vegetation)

LINE 17 — LOCAL LABOR_______________________________(Number of Local Laborers Available)

LINE 18 — EQUIPMENT_________________________________(Type, Name, or Nomenclature of Available Cemetery Equipment)

LINE 19 — BURIAL TYPE________________________________(Type of Special Burial Procedure/Ceremony Requested)

LINE 20 — PERSONNEL QUANTITY AND CLASS___________(Quantity and Classification of Remains (Military and Whether US, Allied, or Enemy))

**Transmit lines 19 and 20 for a special burial request.

**Repeat lines 19 through 20 to request multiple types of special burial procedures/ceremonies. Assign sequential line numbers to succeeding iterations; for example, first iteration 19 through 20; second iteration 19a through 20a; third iteration 19b through 20b; and so on.

LINE 21 — BURIAL JUSTIFICATION______________________(Reason for Requesting Mass Burial)

LINE 22 — NARRATIVE_________________________________(Free Text for Additional Information Required for Clarification of Report)

LINE 23 — AUTHENTICATION___________________________(Report Authentication)

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