7ERVCPPRRRRRRR R" R, R6R6R6R6R6 RVRVRVRV************************************************************************ * NOTICE! * ************************************************************************ * Use your own favorite word processor to add the following * * standard header on all but the first page of this form. * * Insert the property name, county and state, and use a * * running page number. * * * * * USDI/NPS NRHP Registration Form (Property Name) (County and State) (Page #) ************************************************************************ * The complete text from sections 3 (if applicable), 7, 8, and * * the bibliography from section 9 should be printed on continuation* * sheets. Use the header shown on the sample continuation * * sheet at the end of this file, filling in the property * * name and section number, and using a running page number. * ************************************************************************ NPS Form 10900 OMB No. 10240018 (Rev. 1090) United States Department of the Interior National Park Service NATIONAL REGISTER OF HISTORIC PLACES REGISTRATION FORM This form is for use in nominating or requesting determinations for individual properties and districts. See instructions in How to Complete the National Register of Historic Places Registration Form (National Register Bulletin 16A). Complete each item by marking "x" in the appropriate box or by entering the information requested. If any item does not apply to the property being documented, enter "N/A" for "not applicable." For functions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. Place additional entries and narrative items on continuation sheets (NPS Form 10900a). Use a typewriter, word processor, or computer, to complete all items. =============================================================================== 1. Name of Property =============================================================================== historic name _________________________________________________________ other names/site number ________________________________________________ =============================================================================== 2. Location =============================================================================== street & number __________________________________________ not for publication ___ city or town ____________________________________________ vicinity ___ state _____________ code ____ county _____________ code ____ zip code __________ ============================================================================== 3. State/Federal Agency Certification ============================================================================== As the designated authority under the National Historic Preservation Act of 1966, as amended, I hereby certify that this ____ nomination ____ request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion, the property ____ meets ____ does not meet the National Register Criteria. I recommend that this property be considered significant ___ nationally ___ statewide ___ locally. ( ___ See continuation sheet for additional comments.) ________________________________________________ _______________________ Signature of certifying official Date ________________________________________________________________________ State or Federal agency and bureau ============================================================================== In my opinion, the property ____ meets ____ does not meet the National Register criteria. ( ___ See continuation sheet for additional comments.) ________________________________________________ _______________________ Signature of commenting or other official Date ________________________________________________________________________ State or Federal agency and bureau ============================================================================== 4. National Park Service Certification ============================================================================== I, hereby certify that this property is: ____ entered in the National Register ______________________ _________ ___ See continuation sheet. ____ determined eligible for the ______________________ _________ National Register ___ See continuation sheet. ____ determined not eligible for the ______________________ _________ National Register ____ removed from the National Register ______________________ _________ ____ other (explain): _________________ __________________________________ ______________________ _________ Signature of Keeper Date of Action ================================================================================ 5. Classification ================================================================================ Ownership of Property (Check as many boxes as apply) ___ private ___ publiclocal ___ publicState ___ publicFederal Category of Property (Check only one box) ___ building(s) ___ district ___ site ___ structure ___ object Number of Resources within Property Contributing Noncontributing _____ _____ buildings _____ _____ sites _____ _____ structures _____ _____ objects _____ _____ Total Number of contributing resources previously listed in the National Register _____ Name of related multiple property listing (Enter "N/A" if property is not part of a multiple property listing.) ________________________________________________ ================================================================================ 6. Function or Use ================================================================================= Historic Functions (Enter categories from instructions) Cat: ____________________________ Sub: ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ Current Functions (Enter categories from instructions) Cat: ____________________________ Sub: ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ____________________________ ================================================================================= 7. Description ================================================================================= Architectural Classification (Enter categories from instructions) _________________________________________ _________________________________________ _________________________________________ Materials (Enter categories from instructions) foundation _______________________________ roof _______________________________ walls _______________________________ _______________________________ other _______________________________ _______________________________ Narrative Description (Describe the historic and current condition of the property on one or more continuation sheets.) ================================================================================= 8. Statement of Significance ================================================================================= Applicable National Register Criteria (Mark "x" in one or more boxes for the criteria qualifying the property for National Register listing) ____ A Property is associated with events that have made a significant contribution to the broad patterns of our history. ____ B Property is associated with the lives of persons significant in our past. ____ C Property embodies the distinctive characteristics of a type, period, or method of construction or represents the work of a master, or possesses high artistic values, or represents a significant and distinguishable entity whose components lack individual distinction. ____ D Property has yielded, or is likely to yield information important in prehistory or history. Criteria Considerations (Mark "X" in all the boxes that apply.) ____ A owned by a religious institution or used for religious purposes. ____ B removed from its original location. ____ C a birthplace or a grave. ____ D a cemetery. ____ E a reconstructed building, object,or structure. ____ F a commemorative property. ____ G less than 50 years of age or achieved significance within the past 50 years. Areas of Significance (Enter categories from instructions) ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ ______________________________ Period of Significance __________________________ __________________________ __________________________ Significant Dates ________ ________ ________ Significant Person (Complete if Criterion B is marked above) _______________________________ Cultural Affiliation ________________________________ ________________________________ ________________________________ Architect/Builder ___________________________________ ___________________________________ Narrative Statement of Significance (Explain the significance of the property on one or more continuation sheets.) ================================================================================= 9. Major Bibliographical References ================================================================================= (Cite the books, articles, and other sources used in preparing this form on one or more continuation sheets.) Previous documentation on file (NPS) ___ preliminary determination of individual listing (36 CFR 67) has been requested. ___ previously listed in the National Register ___ previously determined eligible by the National Register ___ designated a National Historic Landmark ___ recorded by Historic American Buildings Survey # __________ ___ recorded by Historic American Engineering Record # __________ Primary Location of Additional Data ___ State Historic Preservation Office ___ Other State agency ___ Federal agency ___ Local government ___ University ___ Other Name of repository: ___________________________________ ================================================================================= 10. Geographical Data ================================================================================= Acreage of Property ___________ UTM References (Place additional UTM references on a continuation sheet) Zone Easting Northing Zone Easting Northing 1 __ ______ _______ 3 __ ______ _______ 2 __ ______ _______ 4 __ ______ _______ ___ See continuation sheet. Verbal Boundary Description (Describe the boundaries of the property on a continuation sheet.) Boundary Justification (Explain why the boundaries were selected on a continuation sheet.) ================================================================================= 11. Form Prepared By =============================================================================== name/title____________________________________ e-mail address___________________ organization________________________________________ date_____________________ street & number____________________________________ telephone_________________ city or town_________________________________ state____ zip code _____________ =============================================================================== Additional Documentation =============================================================================== Submit the following items with the completed form: Continuation Sheets Maps A USGS map (7.5 or 15 minute series) indicating the property's location. A sketch map for historic districts and properties having large acreage or numerous resources. Photographs Representative black and white photographs of the property. Additional items (Check with the SHPO or FPO for any additional items) ================================================================================= Property Owner ================================================================================= (Complete this item at the request of the SHPO or FPO.) name ____________________________________________________________ street & number___________________________________ telephone_________________ city or town____________________________________ state_____ zip code __________ ================================================================================== Paperwork Reduction Act Statement: This information is being collected for applications to the National Register of Historic Places to nominate properties for listing or determine eligibility for listing, to list properties, and to amend existing listings. Response to this request is required to obtain a benefit in accordance with the National Historic Preservation Act, as amended (16 U.S.C. 470 et seq.). Estimated Burden Statement: Public reporting burden for this form is estimated to average 18.1 hours per response including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding this burden estimate or any aspect of this form to the Chief, Administrative Services Division, National Park Service, P.0. Box 37127, Washington, DC 200137127; and the Office of Management and Budget, Paperwork Reductions Project (10240018), Washington, DC 20503. NPS Form 10900a OMB No. 10240018 (886) United States Department of the Interior National Park Service NATIONAL REGISTER OF HISTORIC PLACES CONTINUATION SHEET Section _____ Page ___ ______________________________ name of property ______________________________ county and State ================================================================================= ************************************************************************ * NOTICE * * * * The complete text from sections 3 (if applicable), 7, 8, and * * the bibliography from section 9 should be printed on contin * * uation sheets, of which this is a sample. Use the header * * shown at the top of this page, filling in the name of the * * property, county and State, and section number, and using * * a running page number. When the property being documented * * is part of a multiple property listing, use the alternative * * header given below. * ************************************************************************  }~hEEEHI$mH  X3|Xef  % u   X d  O g;qr. ?@#rPh45]^67 :Yxb0JKop6[\R Ae@ S . w ! ! !\!k!!"0"a""""#&#X####$g$$%)%%&&F&G&&'({(|(() ))A)B)j)k))))))*C*^*_** 0Z*++<+r++,,J,K,},,,,--3-4-q---.%.[.../P/S//000001161r112"2#2G2n22222223Q3g3334#4$4b445 5 5j5k566.6~6677 7o7p7788)8y88888999999: :!:s::; ;N;Ob;O;;;;