Historic Property Inventory Form Page 2

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Complete Historic Property Inventory Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

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Present Owners

Owners Mailing Address

Phone #

Describe Setting

_____________ Acres

_____ Archaeological

Artifacts Present

Description of Building or Site (Original and Present)

__________Stories

_________Front Bays

(Use Continuation Sheets)

Alterations

If yes, describe

Yes

Additions

If yes, describe

Yes

Describe All Outbuildings

(Use Continuation Sheets)

Statement of Significance

(Use Continuation Sheets)

Bibliographical References

(Use Continuation Sheets)

Form Prepared By:

Date:

Name/Organization:

Address:

Phone #:

This program receives federal funds from the National Park Service. Regulations of the U. S. Department of the Interior prohibit unlawful discrimination in department Federally Assisted

Programs on the basis of race, color, national origin, age or handicap. Any person who believes he or she has been discriminated against in any program, activity, or facility operated by a

recipient of Federal Assistance should write to: Director, Equal Opportunity Program, U.S. Department of the Interior, National Park Service, P.O. Box 37127, Washington, D.C. 20013-7127.