If you would like to apply for a historic plaque for your house or other building, print this page, fill out the information, and return it to the address above.
Name of Applicant(s)_____________________________________
Mailing Address _________________________________________
Phone # ________________________________________________
Address of Historic Property _______________________________
Tax Parcel Number _____________________ Master Site
File? ________________
Building Permit # ______________________ Certificate
of Appropriateness # ____________
Historic Survey Available? ____________________ (Attach if available)
Desired name on plaque (Not current resident. Preferably the original owner or most significant owner) and the year the building was constructed.______________________________________
Description and History of the Property (Include descriptions of any
work on the building past or current, original builder and owner, and significant
owners) Additional pages may be attached:
Attach Photo(s)
Site visited by_____________________ On ________________________
Information verified by_________________________________________
Application Approved___________________________________________
Tier Two Marker Awarded ($100) **Payment Received** Date____________
Tier One Plaque Awarded ($135) ** Payment Received** Date____________
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