Prince Albert Municipal Heritage Award (Page 4 of 4) in pdf

Prince Albert Municipal Heritage Award Page 4

PRINCE ALBERT MUNICIPAL HERITAGE AWARD

NOMINATION FORM

Please attach your written submission and supporting material to this form and return to:

Community Services Department on the third Floor at City Hall (1084 Central Ave,

Prince Albert, SK, S6V 7P3)

NOMINATOR (owner or designate)

Name:

Address:

Phone No:

REGISTERED OWNER(s)

Name:

Address:

Phone No:

BUILDING: Civic Address

Name of Building:

*Nominators are responsible for informing and obtaining consent from all parties involved and

mentioned in the submission of the nomination.

*The name of any contributors to the project (e.g. architects, organizations, etc.) may appear on

the award.

Category of Entry:

[ ] Restoration – Interior

[ ] Restoration – Exterior

[ ] Rehabilitation

[ ] New Design – Sensitive Infill

[ ] New Design – Sensitive Addition

[ ] Heritage Open Space

CONSENT OF REGISTERED PROPERTY OWNER (S)

I, _______________, as the registered owner(s) of this property, have read and understand the attached Guidelines,

nomination and selection procedure and consent to have my property nominated for a Prince Albert Municipal

Heritage Award. I consent to and understand that all information submitted as part of the nomination (and any that

subsequently be submitted) will become public and may be used for the award plaque (to be displayed at City Hall),

information brochure and map with the location of the property (to be distributed at the Visitor Information Centre);

and that this may be posted on the City of Prince Albert Web site. I also consent to and understand that the City of

Prince Albert may choose to obtain or take a photograph of the building for the Award Plaque. I have reviewed the

information provided on this form and the information to be submitted and consent to its use for any purposes

related to the award.

__________________________________

____________________________

Signature of Registered Property Owner(s)

Date

Prince Albert Municipal Heritage Award Page 4