7. Description
Condition Check One Check one
____excellent ____deteriorated ____unaltered ____original site
____good ____ruins ____altered ____moved (if so, date moved ___________________)
Describe the present and original (if known) physical appearance_____________________________________________
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8. Significance (Continue on separate sheets if necessary)
Period Areas of Significance-Check and justify below
____prehistoric ____archeology-prehistoric ____community planning ____landscape architecture ____religion
____1400-1499 ____archeology-historic ____conservation ____ law ____science
____1500-1599 ____agriculture ____economics ____literature ____sculpture
____1600-1699 ____architecture ____education ____military ____social/
____1700-1799 ____art ____engineering ____music humanitarian
____1800-1899 ____commerce ____exploration/settlement ____philosophy ____theater
____1900- ____communications ____industry ____politics/government ____transportation
____invention ____other (specify)
Specific dates______________________________ Builder/Architect___________________________________________________
Statement of Significance
(Give specific sources for all statements of fact.)
9. Major Bibliographical References
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10. Geographical Data
Acreage of nominated property _________________________
Quadrangle name ________________________________________ Quadrangle scale _______________________________
UMT References
(Optional)
Zone Easting Northing Zone Easting Northing
A __________________________________________________ B __________________________________________________
C __________________________________________________ D __________________________________________________
E __________________________________________________ F __________________________________________________
G __________________________________________________ H __________________________________________________
Verbal boundary description and justification __________________________________________________________________
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