PIONEER CEMETERY PROGRAM - Kentucky Historical Society

KHS Pioneer Cemetery Program
Cemetery Marker Requisition Form
Cemetery name
Address City Zip
Registration number
Pioneer Cemetery contact person(s)
Address City Zip
Phone number
Fax number
Email address
Signature of person(s) purchasing marker
Organization’s Federal ID Number (if applicable)
NOTE: If an organization is purchasing a marker and the organization has 501(c) (3) non-profit
status, please include a copy of your letter from the IRS with this requisition.
Please include the appropriate payment with this requisition and mail to:
Kentucky Historical Society
Pioneer Cemetery Program
100 West Broadway
Frankfort, Kentucky 40601
6