ࡱ> q  6bjbjt+t+ sAA}_]$,,,,P|Pd,r Al4$z"A +  ,, fxq;,,Site Inventory Form State Inventory No.  FORMTEXT        FORMCHECKBOX  New  FORMCHECKBOX  Supplemental State Historical Society of Iowa  FORMCHECKBOX  Part of a district with known boundaries (enter inventory no.)  FORMTEXT       (December 1, 1999) Relationship:  FORMCHECKBOX  Contributing  FORMCHECKBOX  Noncontributing  FORMCHECKBOX  Contributes to a potential district with yet unknown boundaries National Register Status:(any that apply)  FORMCHECKBOX  Listed  FORMCHECKBOX  De-listed  FORMCHECKBOX  NHL  FORMCHECKBOX  DOE 9-Digit SHPO Review & Compliance Number  FORMTEXT        FORMCHECKBOX  Non-Extant (enter year)  FORMTEXT       1. Name of Property historic name  FORMTEXT       other names/site number  FORMTEXT       2. Location street & number  FORMTEXT       city or town  FORMTEXT        FORMCHECKBOX  vicinity, county  FORMTEXT       Legal Description: (If Rural) Township Name Township No. Range No. Section Quarter of Quarter  FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT     FORMTEXT     FORMTEXT    (If Urban) Subdivision  FORMTEXT       Block(s)  FORMTEXT       Lot(s)  FORMTEXT       3. State/Federal Agency Certification [Skip this Section] 4. National Park Service Certification [Skip this Section] 5. Classification Category of Property (Check only one box) Number of Resources within Property  FORMCHECKBOX  building(s) If Non-Eligible Property If Eligible Property, enter number of:  FORMCHECKBOX  district Enter number of: Contributing Noncontributing  FORMCHECKBOX  site  FORMTEXT    buildings  FORMTEXT     FORMTEXT    buildings  FORMCHECKBOX  structure  FORMTEXT    sites  FORMTEXT     FORMTEXT    sites  FORMCHECKBOX  object  FORMTEXT    structures  FORMTEXT     FORMTEXT    structures  FORMTEXT    objects  FORMTEXT     FORMTEXT    objects  FORMTEXT    Total  FORMTEXT     FORMTEXT    Total Name of related project report or multiple property study (Enter  N/A if the property is not part of a multiple property examination). Title Historical Architectural Data Base Number  FORMTEXT        FORMTEXT       6. Function or Use Historic Functions (Enter categories from instructions) Current Functions (Enter categories from instructions)  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       7. Description Architectural Classification (Enter categories from instructions) Materials (Enter categories from instructions)  FORMTEXT       foundation  FORMTEXT        FORMTEXT       walls  FORMTEXT        FORMTEXT       roof  FORMTEXT        FORMTEXT       other  FORMTEXT   Narrative Description ( FORMCHECKBOX  SEE CONTINUATION SHEETS, WHICH MUST BE COMPLETED) 8. Statement of Significance Applicable National Register Criteria (Mark x representing your opinion of eligibility after applying relevant National Register criteria)  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  More Research Recommended A Property is associated with significant events.  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  More Research Recommended B Property is associated with the lives of significant persons.  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  More Research Recommended C Property has distinctive architectural characteristics.  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  More Research Recommended D Property yields significant information in archaeology or history. County  REF County   Address  REF StreetAddress    Site Number  REF SiteNo   City  REF City   District Number  REF District   Criteria Considerations  FORMCHECKBOX  A Owned by a religious institution or used  FORMCHECKBOX  E A reconstructed building, object, or structure. for religious purposes.  FORMCHECKBOX  F A commemorative property.  FORMCHECKBOX  B Removed from its original location.  FORMCHECKBOX  G Less than 50 years of age or achieved significance within the past  FORMCHECKBOX  C A birthplace or grave. 50 years.  FORMCHECKBOX  D A cemetery Areas of Significance (Enter categories from instructions) Significant Dates Construction date  FORMTEXT        FORMTEXT        FORMCHECKBOX  check if circa or estimated date Other dates  FORMTEXT    FORMTEXT   Significant Person Architect/Builder (Complete if National Register Criterion B is marked above) Architect  FORMTEXT    FORMTEXT       Builder  FORMTEXT    FORMTEXT       Narrative Statement of Significance ( FORMCHECKBOX  SEE CONTINUATION SHEETS, WHICH MUST BE COMPLETED) 9. Major Bibliographical References Bibliography  FORMCHECKBOX  See continuation sheet for citations of the books, articles, and other sources used in preparing this form 10. Geographic Data UTM References (OPTIONAL) Zone Easting Northing Zone Easting Northing 1  FORMTEXT     FORMTEXT        FORMTEXT       2  FORMTEXT     FORMTEXT    FORMTEXT   3  FORMTEXT     FORMTEXT        FORMTEXT       4  FORMTEXT     FORMTEXT    FORMTEXT    FORMCHECKBOX  See continuation sheet for additional UTM references or comments 11. Form Prepared By name/title  FORMTEXT       organization  FORMTEXT       date  FORMTEXT       street & number  FORMTEXT       telephone  FORMTEXT       city or town  FORMTEXT       state  FORMTEXT       zip code  FORMTEXT       ADDITIONAL DOCUMENTATION (Submit the following items with the completed form) FOR ALL PROPERTIES 1. Map: showing the property s location in a town/city or township. 2. Site plan: showing position of buildings and structures on the site in relation to public road(s). 3. Photographs: representative black and white photos. If the photos are taken as part of a survey for which the Society is to be curator of the negatives or color slides, a photo/catalog sheet needs to be included with the negatives/slides and the following needs to be provided below on this particular inventory site: Roll/slide sheet #  FORMTEXT       Frame/slot #  FORMTEXT       Date Taken  FORMTEXT       Roll/slide sheet #  FORMTEXT       Frame/slot #  FORMTEXT       Date Taken  FORMTEXT       Roll/slide sheet #  FORMTEXT       Frame/slot #  FORMTEXT       Date Taken  FORMTEXT        FORMCHECKBOX  See continuation sheet or attached photo & slide catalog sheet for list of photo roll or slide entries.  FORMCHECKBOX  Photos/illustrations without negatives are also in this site inventory file. FOR CERTAIN KINDS OF PROPERTIES, INCLUDE THE FOLLOWING AS WELL 1. Farmstead & District: (List of structures and buildings, known or estimated year built, and contributing or non-contributing status) 2. Barn: a. A sketch of the frame/truss configuration in the form of drawing a typical middle bent of the barn. b. A photograph of the loft showing the frame configuration along one side. c. A sketch floor plan of the interior space arrangements along with the barns exterior dimensions in feet. State Historic Preservation Office (SHPO) Use Only Below This Line Concur with above survey opinion on National Register eligibility:  FORMCHECKBOX  Yes  FORMCHECKBOX  No  FORMCHECKBOX  More Research Recommended  FORMCHECKBOX  This is a locally designated property or part of a locally designated district. Comments: Evaluated by (name/title): Date: Iowa Department of Cultural Affairs State Historical Society of Iowa Site Number  REF SiteNo   Iowa Site Inventory Form Related District Number  REF District   Continuation Sheet Page  PAGE 1  REF histname    REF County   Name of Property County  REF StreetAddress    REF City   Address City (PRfhjtvxz$&(DFHJ񷲦ynhZnj>*OJQJU >*OJQJj>*OJQJUj^5OJQJUj5OJQJU5CJOJQJjOJQJUjvOJQJUOJQJjOJQJUj5>*OJQJUmHj5>*OJQJU5>*OJQJj5>*OJQJU 5OJQJ5CJOJQJ _Aq`d$d&d$d x$d N ")$d N ")$d N $d N $d N j$d N X ")$d N l _A  b d ~ >  \ Px8,46DFf,BjlGUuv !!f!!"L"`""##$$%J%%&&''(T(d *+,-9=>LMNO`aopqr#$%+,:϶ϨϚՑՅՑyՑmՑj|OJQJUjOJQJUjOJQJUjOJQJUj5OJQJUj5OJQJUjL5OJQJUj5OJQJU 5OJQJOJQJ CJOJQJ CJOJQJj>*OJQJUj>*OJQJUmH*:;<jkuv  .02fh|~  : < P ٴ块|v块h|块j>*OJQJU 5OJQJj>*OJQJUmHjF>*OJQJU >*OJQJj>*OJQJUjOJQJUj5>*OJQJUmHjh5>*OJQJU5>*OJQJj5>*OJQJUOJQJjOJQJUjOJQJU#  b d ~ >  p$d ~ <!%$d T~ <!$%+ 84")$d ")d$d&d$d $ ")$d ") $d P R T ^ ` b d ~   ( * , X Z n p r | ~ B D X Z \ f h j l ϻϭդ՘ϊ|jh >*OJQJUj>*OJQJUjOJQJUjOJQJUj>*OJQJUj>*OJQJU 5OJQJ >*OJQJOJQJj>*OJQJUmHj>*OJQJUj*>*OJQJU+      N P d f h r t ϳϥϗω{j. >*OJQJUj >*OJQJUjj >*OJQJUj >*OJQJUj >*OJQJUj< >*OJQJU >*OJQJOJQJj>*OJQJUmHj>*OJQJUj >*OJQJU0 6 X '(KOPQR`abp  ȳȬȤΙ~ΙpΙbj CJOJQJUjj CJOJQJU 6OJQJj CJOJQJU CJOJQJjCJOJQJU5>*OJQJ CJOJQJj5OJQJUmH56OJQJ 5OJQJOJQJj>*OJQJUmHj>*OJQJUj >*OJQJU >*OJQJ& \ Px8}hR$d ^X @@$d ^X @$d jP@$d jP@$d j@d$d&d dd$d&d +$d hF~ r"$  !246:<>@TVX\^z|޵ާބvj >*OJQJUj>*OJQJUjHCJOJQJU CJOJQJj>*OJQJUj>*OJQJUj>*OJQJUmHj:>*OJQJU >*OJQJj>*OJQJUOJQJjCJOJQJU, $&:<XZ\np  "&(<>RTõ篡篓篅wij>*OJQJUj4>*OJQJUj>*OJQJUj>*OJQJUj&>*OJQJU >*OJQJjCJOJQJU CJOJQJjCJOJQJUOJQJj>*OJQJUmHj>*OJQJUjd>*OJQJU)8,4{p`$d r") $d$d r@d$d&d$d  ")@$d  @ pd$d @$d ^X @@$d ^X @@ TVZ\^`tvx|~*,ݳݥ㟗zjP>*OJQJU6CJOJQJ CJOJQJ5CJOJQJ 5OJQJj>*OJQJUj>*OJQJUjB>*OJQJUj>*OJQJU >*OJQJOJQJj>*OJQJUmHj>*OJQJU/*r  "$&0268LNPZ\^`tvxԴԦԘԊ|j|>*OJQJUj">*OJQJUj>*OJQJUjn>*OJQJUj>*OJQJUOJQJ CJOJQJ 5OJQJ >*OJQJj>*OJQJUmHj>*OJQJUj>*OJQJU046DF$d rl@$d r")@$d r@d$d&d$d $d r")$d Vr 4|246@BDFH\^`jlz|{j>*OJQJUj>>*OJQJUj>*OJQJUj>*OJQJUj0>*OJQJU CJOJQJ 5OJQJOJQJj>*OJQJUmHj>*OJQJUj>*OJQJU >*OJQJ0$&46JLNbdf,QR𘑃}u}n} CJOJQJ5CJOJQJ 5OJQJj CJOJQJU CJOJQJjCJOJQJU5CJOJQJ>*OJQJmHj>*OJQJUjL>*OJQJUj>*OJQJUmHj>*OJQJU >*OJQJOJQJj>*OJQJU&f,Bjl+ddx ") $ #6$")€$ N #6$")$d dd$d&d $d$d r")@$d rl@ BCQRSXYghimn|}~ھکڛڍqjJCJOJQJUjCJOJQJUjzCJOJQJUjCJOJQJUjCJOJQJU CJOJQJjBCJOJQJUjCJOJQJU CJOJQJOJQJjCJOJQJUjrCJOJQJU+2ijkyz{!"+,?@EGIJWXdejklqr|}ӷөڜڜڜڜڜ5>*OJQJmH>*OJQJmH>*CJOJQJj>*CJOJQJUjCJOJQJUjCJOJQJUjCJOJQJU CJOJQJ CJOJQJOJQJjCJOJQJUjCJOJQJU3`aopq ./0VWeŷ̰Ţ̰Ŕ̰ņ̰x̰j̰jZ!CJOJQJUj CJOJQJUj CJOJQJUj" CJOJQJUjCJOJQJU CJOJQJjRCJOJQJU CJOJQJjCJOJQJUOJQJ >*OJQJ>*OJQJmHj>*CJOJQJU>*CJOJQJ(GUuv !!f!!{$d d") + d$ d ($d d $d$d :V$d :V$d :Vefgtu   $ & ( 2 4 6 8 T V X Z źͺvźh`>*OJQJmHjR#>*OJQJUj"CJOJQJU CJOJQJj">*OJQJUj>*OJQJUmHj*">*OJQJU >*OJQJj>*OJQJU6CJOJQJ CJOJQJ 5OJQJOJQJ CJOJQJjCJOJQJUj!CJOJQJU% !!!!!f!!!!" 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