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APPLICATION FOR LICENSE TO PROBE FOR GRAVE MEMORIAL RESTORATION PROJECTS IN A CEMETERY
State Form 53862 (12-08)

INDIANA DEPARTMENT OF NATURAL RESOURCES DIVISION OF HISTORIC PRESERVATION AND ARCHAEOLOGY 402 West Washington Street, Room W274 Indianapolis, Indiana 46204-2739 Telephone: (317) 232-1646 Fax: (317) 232-0693 E-mail: [email protected]

This application is a license to probe the ground to locate fallen grave memorials in known cemeteries, recover fallen grave memorials, and restore or reset memorials in a cemetery. This application is not for the locating of graves, artifacts, or scientific work in a cemetery. If human remains are found during any stage of the probing or restoration, work must stop immediately and the department notified.
Authority: Natural Resources Commission Emergency Rule #08-899

Applicant: Individual Name: Company (if applicable): Address (number and street): City: Telephone number: State: ZIP Code: E-mail address:

Cemetery Information: Cemetery Name (only one cemetery per application): County: Address or GPS reading: City: Civil Township: Cemetery Registry Number
(for help with this, contact the Cemetery and Burial Ground Registry Coordinator):

Project Information:

Approximate number of known burials in the Cemetery: Approximate number of stones or pieces will be recovered: Will the pieces be taken off site in order to be cleaned and repaired? If yes, where will the pieces be stored, cleaned and repaired?

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Describe the work to be done in the project. Be sure to explain how memorials pieces will be located, received and restored.

Checklist for Application:
1. Written permission from the cemetery land owner showing permission for the work to be completed must be included. 2. If land owned by a person other the cemetery owner will be crossed to access the cemetery, a document showing permission to cross the land must be included. 3. Within sixty (60) days of the completion of the work, the applicant must submit a report summarizing findings of the project to the division. For a copy of the report template, contact the Cemetery Registry Coordinator at (317) 234-1268. 4. Contact the Indiana Division of Historic Preservation and Archaeology with questions by calling the Cemetery Registry Coordinator at (317) 234-1268. 5. Submit your application and report to the Indiana Division of Historic Preservation and Archaeology, Cemetery Registry Coordinator, 402 W. Washington Street, Room W274, Indianapolis, Indiana 46204-2739.

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