Information Sheet for a Request 

To the Council on American Indian Concerns 

for Study of a Suspected or Proven Burial Site 

(Incomplete Forms are Welcomed)


I. Name of Interested party or Group: ____________________________________


Name of Contact Person: ____________________________________ 


Address of Contact Person: ____________________________________ 

____________________________________


Telephone Number: (    ) ______________________ 

II. If Applicable, American Indian tribe or affiliation 

_______________________________________________________________ 


III. Location of site of known or suspected burials: 

______________________________________________________________________________________________________________


IV. Owner of property__________________________________Phone________________ 

Address:________________________________________________________________ 


V. Please list the nature of the evidence you have of aboriginal, prehistoric, or American Indian burials at this site. 

A. Maps: _____ 

B. Books: _____ 

C. Records: _____ 

D. Statements of persons with knowledge: _____ 

1. Persons with historical or traditional knowledge: _____ 

2. Persons who have actually seen physical indications of a burial: _____ 

Please attach copies of the relevant portions of such maps, books or records. 

Please attach written statements of persons with knowledge.


VI. Has the site been surveyed by a professional archeologist? Yes___ No____ 

Please attach a copy of any archeological report.



VII. What applications for development or environmental permits or zoning changes are pending or have been issued? Has the appeal period expired? 

______________________________________________________________________________________________________________

CONTINUED ON THE REVERSE


VIII. Do you or your group oppose the application(s) for development or environmental permits or zoning changes even if proper and legal steps are taken to protect any burial site(s) or mitigate any disturbance? _______

IX. What development or land use change of the actual burial site(s) is occurring or is about to occur? 

______________________________________________________________________________________________________________

X. Please concisely state why you believe the Council on American Indian Concerns should study this site. 
_______________________________________________________________________________________________________________

XI. Please detail what action, if any, you believe is needed by the Council? 

______________________________________________________________________________________________________________

XII. The Georgia Council on American Indian Concerns acts under provisions of the Georgia Code (44-12-260 through 285). Please list other Georgia or federal statutes or laws which you feel are applicable in this situation. 
______________________________________________________________________________________________________________


Date:___________ Signature:_______________________________________ 

Title:___________________________________________ 

For further information call (770) 389-7265. Please fold and staple and return this form to the address below: 







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Return Address 

____________________________ 

____________________________ 

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                                                                 Council on American Indian Concerns 
                                                                 c/o Historic Sites Region Office
                                                                 2600 Highway 155 SW, Suite D
                                                                 Stockbridge, GA 30281