NATIONAL REGISTER FORMS TEMPLATE

January 2006

[To format the following document]{.underline}, make the following
adjustments: left and right margins = .29; top and bottom margins = .25;
justification =left

and line spacing =1.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

\* 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 #)

\* Use the following alternative header when documenting \*

\* properties within multiple property listings. \*

\* \*

USDI/NPS NRHP Registration Form

(Property Name)

(County and State)

(Name of Multiple Property Listing) (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 10‑900 OMB No. 1024‑0018

(Rev. Aug. 2002) (Expires 1-31-2009)

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 10‑900a). 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, 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 or Tribal government

In my opinion, the property \_\_\_\_ meets \_\_\_\_ does not meet the
National Register criteria. ( \_\_\_ See continuation sheet for
additional comments.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of commenting official/Title 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

\_\_\_ public‑local

\_\_\_ public‑State

\_\_\_ public‑Federal

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\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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.). A federal agency
may not conduct or sponsor, and a person is not required to respond to a
collection of information unless it displays a valid OMB control number.

Estimated Burden Statement: Public reporting burden for this form is
estimated to range from approximately 18 hours to 36 hours depending on
several factors including, but not limited to, how much documentation
may already exist on the type of property being nominated and whether
the property is being nominated as part of a Multiple Property
Documentation Form. In most cases, it is estimated to average 36 hours
per response including the time for reviewing instructions, gathering
and maintaining data, and completing and reviewing the form to meet
minimum National Register documentation requirements. Direct comments
regarding this burden estimate or any aspect of this form to the Chief,
Administrative Services Division, National Park Service, 1849 C St., NW,
Washington, DC 20240.

NPS Form 10‑900‑a OMB No. 1024‑0018

(8‑86) (Expires 1-31-2009)

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. \*

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

Alternative header (for use when property being documented

is part of a multiple property listing):

NPS Form 10‑900‑a OMB No. 1024‑0018

(8‑86) (Expiration 1-31-2009)

United States Department of the Interior

National Park Service

NATIONAL REGISTER OF HISTORIC PLACES

CONTINUATION SHEET

Section \_\_\_\_\_ Page \_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

name of property

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

county and State

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

name of multiple property listing

===============================================================================

NATIONAL REGISTER FORMS TEMPLATE

National Register of Historic Places Multiple Property Form

January 2006

[To format the following document]{.underline}, make the following
adjustments: left and right margins = .29; top and bottom margins = .25;
justification =left

and line spacing =1.

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

\* \*

\* Notice! \*

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

\*

\* Use your own favorite word processor to add the following \*

\* standard header on all but the first page of this form. \*

\* Insert the name of the multiple property listing and use \*

\* a running page number (#): \*

USDI/NPS NRHP Multiple Property Documentation Form

(Name of Multiple Property Listing) (Page #)

\* \*

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

NPS Form 10‑900‑b OMB No. 1024‑0018

(Rev. Aug. 2002) (Expires 1-31-2009)

United States Department of the Interior

National Park Service

National Register of Historic Places

Multiple Property Documentation Form

This form is used for documenting multiple property groups relating to
one or several historic contexts. See instructions in *How to Complete
the Multiple Property Documentation Form* (National Register Bulletin
16B). Complete each item by entering the requested information. For
additional space, use continuation sheets (Form 10‑900‑a). Use a
typewriter, word processor, or computer to complete all items.

\_\_\_\_ New Submission \_\_\_\_ Amended Submission

===============================================================================

A. Name of Multiple Property Listing

===============================================================================

===============================================================================

B. Associated Historic Contexts

===============================================================================

(Name each associated historic context, identifying theme, geographical
area, and chronological period for each.)

==============================================================================

C. Form Prepared by

==============================================================================

name/title
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

street & number \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
telephone \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

city or town
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_state\_\_\_\_\_\_\_zip
code\_\_\_\_\_\_\_\_

===============================================================================

D. Certification

===============================================================================

As the designated authority under the National Historic Preservation Act
of 1966, as amended, I hereby certify that this documentation form meets
the National Register documentation standards and sets forth
requirements for the listing of related properties consistent with the
National Register criteria. This submission meets the procedural and
professional requirements set forth in 36 CFR Part 60 and the Secretary
of the Interior\'s Standards and Guidelines for Archeology and Historic
Preservation. (\_\_\_ See continuation sheet for additional comments.)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature and title of certifying official Date

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

State or Federal Agency or Tribal government

I hereby certify that this multiple property documentation form has been
approved by the National Register as a basis for evaluating related
properties for listing in the National Register.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Signature of the Keeper Date of Action

===============================================================================

Table of Contents for Written Narrative

===============================================================================

Provide the following information on continuation sheets. Cite the
letter and the title before each section of the narrative. Assign page
numbers according to the instructions for continuation sheets *in How to
Complete the Multiple Property Documentation Form* (National Register
Bulletin 16B). Fill in page numbers for each section in the space below.

Page Numbers

E. Statement of Historic Contexts (If more

than one historic context is documented,

present them in sequential order.)

F. Associated Property Types (Provide

description, significance, and registration

requirements.)

G. Geographical Data

H. Summary of Identification and Evaluation

Methods (Discuss the methods used in developing

the multiple property listing.)

I. Major Bibliographical References (List major

written works and primary location of additional

documentation: State Historic Preservation Office,

other State agency, Federal agency, local government,

university, or other, specifying repository.)

===============================================================================

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.).Number range
CHAPTER A federal agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a
valid OMB control number.

Estimated Burden Statement: Public reporting burden for this form is
estimated to average 120 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 Number range CHAPTERNational Register
of Historic Places, National Park Service, 1849 C St., NW, Washington,
DC 20240.