State Antiquities Landmark Nomination Form - Texas Historical Commission Page 3
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5. Application Preparer
Name ______________________________________________________________________________
Address ____________________________________________________________________________
City _______________________________ County __________________________ State __________
Telephone# _________________________________________________________________________
Email Address _______________________________________________________________________
Nominator’s Signature __________________________________________________ Date __________
6. Property Owner
Name ______________________________________________________________________________
Address ____________________________________________________________________________
City _______________________________ County __________________________ State __________
Telephone# _________________________________________________________________________
Email Address _______________________________________________________________________
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Additional owner information is attached.
7. Acknowledgments by Private Property Owners
I, _______________________________________________, as owner of this property, understand that if this site is accepted and
entered into the Commission’s records as a State Antiquities Landmark, it will thereafter be protected by, and its use governed by,
the Antiquities Code of Texas insofar as provided in that Code. Furthermore, I understand that if the site is designated as a State
Antiquities Landmark, a “Notice of Designation as a State Antiquities Landmark,” will be recorded in the deed records in the
county in which the property is located. Furthermore, if the nominated property is building or structure, I understand that I must
purchase a State Antiquities Landmark medallion. Furthermore, I understand that, in accordance with Section 191.097 of the
Antiquities Code of Texas, the Commission may remove the designation of State Antiquities Landmark from the site if it is
determined that such designation is no longer warranted. Furthermore, I swear that I am the owner of the parcel of land nominated
for designation as a State Antiquities Landmark, or have consent of a legal authority to make this nomination, subject to penalty
of law as provided by Texas Penal Code, Sec. 37.10.
Owner’s Signature: ______________________________________________________ Date ___________________
Each private property owner must sign a copy of the nomination.
8. Nomination by Third Party Applicant of Properties owned by Cities and Counties
Any private individual or private group that desires to nominate a property owned by a political subdivision as a landmark must
complete and return to the commission a nomination form, and must give notice of the nomination at the individual's or group's
own expense, in a newspaper of general circulation published in the city, town, or county in which the building, structure or site is
located. If no newspaper of general circulation is published in the city, town, or county, the notice must be published in a
newspaper of general circulation in an adjoining or neighboring county that is circulated in the county of the applicant's residence.
The notice must be printed in 12-point boldface type; include the exact location of the building or site; and include the
name of the group or individual nominating the building or site.
An original copy of the notice and an affidavit of publication signed by the newspaper's publisher must be submitted to
the commission with a nomination form.
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I have complied with this requirement (attach proof of publication)
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