HDD 09/2019 Page 1 of 1
HISTORIC DISTRICT PROPERTY DISCLOSURE
PROPERTY:
______________________________________________________________________________
Municipal Address Subdivision Lot Number Parish
HISTORIC DISTRICT:
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Name Location Municipal Address
1) Is this property an individually locally nominated or designated historic landmark?
□ Yes □ No
2) Does exterior work to this property require review, approval and certification as compliant by a local
historical entity or any other governing body due to its historic status?
□ Yes □ No
3) During current ownership, has all exterior work been reviewed, approved, inspected and certified as
compliant by a local historical entity or any other governing body as of the date indicated below?
□ Yes □ No
4) Are there any pending or open permit applications for the property with a local historical entity or any
other governing body as of the date indicated below?
□ Yes □ No
If yes, please provide details below or attach documentation.
_____________________________________________________________________________________
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5) To the best of the seller’s or sellers’ knowledge, are there any outstanding violations relating to the
historic designation of this property as of the date indicated below?
□ Yes □ No
Sellers acknowledges that the information contained herein is current as of this date.
SELLER _______________________________________________________________________________
sign print Date Time
SELLER _______________________________________________________________________________
sign print Date Time