KING OF PEACE EPISCOPAL CHURCH
Kingsland, GA. 

MARCUS DICKMAN MEMORIAL GARDEN
INTERMENT INFORMATION SHEET

The information provided below serves as official historic data for those whose ashes are interred or for others who are remembered by a memorial marker. 

Full Name of Deceased:____________________________________________________
                                     (First)                       (Middle)                              (Last)

Physical Location of Plaque/Paver ___________________________________________
_______________________________________________________________________

Date of Interment/Placement of Memorial: _____________________________________

Date & Place of Death: ____________________________________________________

Date & Place of Birth: _____________________________________________________

Ceremony Officiant: ______________________________________________________

Family Members/Relatives/Friends Present at Interment/Memorial Ceremony:_________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Pertinent Notes/Remarks:___________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

The information contained on this sheet is used for documenting necessary information in the Parish Register and should also be maintained on file along with any photos or other reasonable documentation desired by the family in support of the individual being memorialized.