+----------+---+-----------+----------------------+---------+-----------+
| Form     | U |           |                      |         | OMB       |
| 10-168a  | N |           |                      |         | Approved  |
|          | I |           |                      |         |           |
| Rev.     | T |           |                      |         | No.       |
| 12/90    | E |           |                      |         | 1024-0009 |
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+----------+---+-----------+----------------------+---------+-----------+
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|          | - |           |                      |         |           |
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|          | O |           |                      |         |           |
|          | N |           |                      |         |           |
+----------+---+-----------+----------------------+---------+-----------+
| NPS      |   |           |                      | NPS     |           |
| Office   |   |           |                      | Office  |           |
| Use Only |   |           |                      | Use     |           |
|          |   |           |                      | Only    |           |
+----------+---+-----------+----------------------+---------+-----------+
| NRIS No: |   |           |                      | Project |           |
|          |   |           |                      | No:     |           |
+----------+---+-----------+----------------------+---------+-----------+
|          |   |           |                      |         |           |
+----------+---+-----------+----------------------+---------+-----------+
| Instr    |   |           |                      |         |           |
| uctions: |   |           |                      |         |           |
| Read the |   |           |                      |         |           |
| inst     |   |           |                      |         |           |
| ructions |   |           |                      |         |           |
| c        |   |           |                      |         |           |
| arefully |   |           |                      |         |           |
| before   |   |           |                      |         |           |
| co       |   |           |                      |         |           |
| mpleting |   |           |                      |         |           |
| the      |   |           |                      |         |           |
| appli    |   |           |                      |         |           |
| cations. |   |           |                      |         |           |
| No       |   |           |                      |         |           |
| certif   |   |           |                      |         |           |
| ications |   |           |                      |         |           |
| will be  |   |           |                      |         |           |
| made     |   |           |                      |         |           |
| unless a |   |           |                      |         |           |
| c        |   |           |                      |         |           |
| ompleted |   |           |                      |         |           |
| app      |   |           |                      |         |           |
| lication |   |           |                      |         |           |
| form has |   |           |                      |         |           |
| been     |   |           |                      |         |           |
| r        |   |           |                      |         |           |
| eceived. |   |           |                      |         |           |
| Type or  |   |           |                      |         |           |
| print    |   |           |                      |         |           |
| clearly  |   |           |                      |         |           |
| in black |   |           |                      |         |           |
| ink. If  |   |           |                      |         |           |
| ad       |   |           |                      |         |           |
| ditional |   |           |                      |         |           |
| space is |   |           |                      |         |           |
| needed,  |   |           |                      |         |           |
| use      |   |           |                      |         |           |
| cont     |   |           |                      |         |           |
| inuation |   |           |                      |         |           |
| sheets   |   |           |                      |         |           |
| or       |   |           |                      |         |           |
| attach   |   |           |                      |         |           |
| blank    |   |           |                      |         |           |
| sheets.  |   |           |                      |         |           |
| A copy   |   |           |                      |         |           |
| of this  |   |           |                      |         |           |
| form may |   |           |                      |         |           |
| be       |   |           |                      |         |           |
| provided |   |           |                      |         |           |
| to the   |   |           |                      |         |           |
| Internal |   |           |                      |         |           |
| Revenue  |   |           |                      |         |           |
| Service. |   |           |                      |         |           |
| The      |   |           |                      |         |           |
| decision |   |           |                      |         |           |
| by the   |   |           |                      |         |           |
| National |   |           |                      |         |           |
| Park     |   |           |                      |         |           |
| Service  |   |           |                      |         |           |
| with     |   |           |                      |         |           |
| respect  |   |           |                      |         |           |
| to       |   |           |                      |         |           |
| certi    |   |           |                      |         |           |
| fication |   |           |                      |         |           |
| is made  |   |           |                      |         |           |
| on the   |   |           |                      |         |           |
| basis of |   |           |                      |         |           |
| the      |   |           |                      |         |           |
| desc     |   |           |                      |         |           |
| riptions |   |           |                      |         |           |
| in this  |   |           |                      |         |           |
| app      |   |           |                      |         |           |
| lication |   |           |                      |         |           |
| form. In |   |           |                      |         |           |
| the      |   |           |                      |         |           |
| event of |   |           |                      |         |           |
| any      |   |           |                      |         |           |
| dis      |   |           |                      |         |           |
| crepancy |   |           |                      |         |           |
| between  |   |           |                      |         |           |
| the      |   |           |                      |         |           |
| app      |   |           |                      |         |           |
| lication |   |           |                      |         |           |
| form and |   |           |                      |         |           |
| other,   |   |           |                      |         |           |
| suppl    |   |           |                      |         |           |
| ementary |   |           |                      |         |           |
| material |   |           |                      |         |           |
| s        |   |           |                      |         |           |
| ubmitted |   |           |                      |         |           |
| with it  |   |           |                      |         |           |
| (such as |   |           |                      |         |           |
| archi    |   |           |                      |         |           |
| tectural |   |           |                      |         |           |
| plans,   |   |           |                      |         |           |
| d        |   |           |                      |         |           |
| rawings, |   |           |                      |         |           |
| and      |   |           |                      |         |           |
| specific |   |           |                      |         |           |
| ations), |   |           |                      |         |           |
| the      |   |           |                      |         |           |
| app      |   |           |                      |         |           |
| lication |   |           |                      |         |           |
| form     |   |           |                      |         |           |
| shall    |   |           |                      |         |           |
| take     |   |           |                      |         |           |
| pre      |   |           |                      |         |           |
| cedence. |   |           |                      |         |           |
+----------+---+-----------+----------------------+---------+-----------+

  --------------- ------------------ --------------------- --------------------- ------------ --------------------- --------------------- --------------------- --------------------- --------------------- ------------------ --------------------- --------------------- --------------------- ------------------------
  1\.                                Name of Property:                                                                                                                                                                                                                                           
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Address of Property:                                                                                                                                                                                                                                        
                                     Street                                                                                                                                                                                                                                                      
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                                           City                                                                           County                                                                               State                                                             Zip[     ]{.underline}
                                                           [     ]{.underline}                                                            [     ]{.underline}                                                                  [     ]{.underline}                                               

                                     Listed individually                                                                                                                                                                                                                                         
                                     in the National                                                                                                                                                                                                                                             
                                     Register of Historic                                                                                                                                                                                                                                        
                                     Places; give date of                                                                                                                                                                                                                                        
                                     listing:                                                                                                                                                                                                                                                    
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Located in a                                                                                                                                                                                                                                                
                                     Registered Historic                                                                                                                                                                                                                                         
                                     District; specify:                                                                                                                                                                                                                                          
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Has a Part 1                                                                                                                                                                                                                                                
                                     Application                                                                                                                                                                                                                                                 
                                     (Evaluation of                                                                                                                                                                                                                                              
                                     Significance) been                                                                                                                                                                                                                                          
                                     submitted for this                                                                                                                                                                                                                                          
                                     project? yes no                                                                                                                                                                                                                                             

                                     If yes, date Part 1                                                            Date of                                                                                                                          NPS Project Number:                         
                                     submitted:                                                                     certification:                                                                                                                   [     ]{.underline}                         
                                     [     ]{.underline}                                                            [     ]{.underline}                                                                                                                                                          

  2\.                                Data on building and                                                                                                                                                                                                                                        
                                     rehabilitation                                                                                                                                                                                                                                              
                                     project:                                                                                                                                                                                                                                                    

                                     Date building                                                                                                              Total number of                                                                                                                  
                                     constructed:                                                                                                               housing units before                                                                                                             
                                     [     ]{.underline}                                                                                                        rehabilitation:                                                                                                                  
                                                                                                                                                                [     ]{.underline}                                                                                                              

                                     Type of construction:                                                                                                      Number that are                                                                                                                  
                                     [     ]{.underline}                                                                                                        low-moderate income:                                                                                                             
                                                                                                                                                                [     ]{.underline}                                                                                                              

                                     Use(s) before                                                                                                              Total number of                                                                                                                  
                                     rehabilitation:                                                                                                            housing units after                                                                                                              
                                     [     ]{.underline}                                                                                                        rehabiltation:                                                                                                                   
                                                                                                                                                                [     ]{.underline}                                                                                                              

                                     Proposed use(s) after                                                                                                      Number that are                                                                                                                  
                                     rehabilitation:                                                                                                            low-moderate income:                                                                                                             
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              

                                     Estimated cost of                                                                                                          Floor area before                                                                                                                
                                     rehabilitation:                                                                                                            rehabilitation:                                                                                                                  
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              

                                     This application                                                                                                           Floor area after                                                                                                                 
                                     covers phase number                                                                                                        rehabilitation:                                                                                                                  
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              
                                     of                                                                                                                                                                                                                                                          
                                     [     ]{.underline}                                                                                                                                                                                                                                         
                                     phases                                                                                                                                                                                                                                                      

                                     Project/phase start                                                                                                        Completion date                                                                                                                  
                                     date (est.):                                                                                                               (est.):                                                                                                                          
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              

  3\.                                Project contact:                                                                                                                                                                                                                                            

                                     Name                                                                                                                                                                                                                                                        
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Street                                                                                                                     City                                                                                                                             
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              

                                     State                                                    Zip                                                                                     Daytime Telephone                                                                                          
                                     [     ]{.underline}                                      [     ]{.underline}                                                                     Number                                                                                                     
                                                                                                                                                                                      [     ]{.underline}                                                                                        

  4\.                                Owner:                                                                                                                                                                                                                                                      

                                     I hereby attest that                                                                                                                                                                                                                                        
                                     the information I                                                                                                                                                                                                                                           
                                     have provided is, to                                                                                                                                                                                                                                        
                                     the best of my                                                                                                                                                                                                                                              
                                     knowledge, correct,                                                                                                                                                                                                                                         
                                     and that I own the                                                                                                                                                                                                                                          
                                     property described                                                                                                                                                                                                                                          
                                     above. I understand                                                                                                                                                                                                                                         
                                     that falsification of                                                                                                                                                                                                                                       
                                     factual                                                                                                                                                                                                                                                     
                                     representations in                                                                                                                                                                                                                                          
                                     this application is                                                                                                                                                                                                                                         
                                     subject to criminal                                                                                                                                                                                                                                         
                                     sanctions of up to                                                                                                                                                                                                                                          
                                     \$10,000 in fines or                                                                                                                                                                                                                                        
                                     imprisonment for up                                                                                                                                                                                                                                         
                                     to five years                                                                                                                                                                                                                                               
                                     pursuant to 18 U.S.C.                                                                                                                                                                                                                                       
                                     1001.                                                                                                                                                                                                                                                       

                                     Name                                                     Signature                                                                                                                                                                    Date                  
                                     [     ]{.underline}                                                                                                                                                                                                                   [     ]{.underline}   

                                     Organization                                                                                                                                                                                                                                                
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Social Security or                                                                                                                                                                                                                                          
                                     Taxpayer                                                                                                                                                                                                                                                    
                                     Identification Number                                                                                                                                                                                                                                       
                                     [     ]{.underline}                                                                                                                                                                                                                                         

                                     Street                                                                                                                     City                                                                                                                             
                                     [     ]{.underline}                                                                                                        [     ]{.underline}                                                                                                              

                                     State                                                    Zip                                                                                     Daytime Telephone                                                                                          
                                     [     ]{.underline}                                      [     ]{.underline}                                                                     Number                                                                                                     
                                                                                                                                                                                      [     ]{.underline}                                                                                        

  NPS Office Use                                                                                                                                                                                                                                                                                 
  Only                                                                                                                                                                                                                                                                                           

  The National                                                                                                                                                                                                                                                                                   
  Park Service                                                                                                                                                                                                                                                                                   
  has reviewed                                                                                                                                                                                                                                                                                   
  the "Historic                                                                                                                                                                                                                                                                                  
  Certification                                                                                                                                                                                                                                                                                  
  Application --                                                                                                                                                                                                                                                                                 
  Part 2" for the                                                                                                                                                                                                                                                                                
  above-named                                                                                                                                                                                                                                                                                    
  property and                                                                                                                                                                                                                                                                                   
  has determined:                                                                                                                                                                                                                                                                                

                  that the                                                                                                                                                                                                                                                                       
                  rehabilitation                                                                                                                                                                                                                                                                 
                  described herein                                                                                                                                                                                                                                                               
                  is consistent with                                                                                                                                                                                                                                                             
                  the historic                                                                                                                                                                                                                                                                   
                  character of the                                                                                                                                                                                                                                                               
                  property or the                                                                                                                                                                                                                                                                
                  district in which                                                                                                                                                                                                                                                              
                  it is located and                                                                                                                                                                                                                                                              
                  that the project                                                                                                                                                                                                                                                               
                  meets the                                                                                                                                                                                                                                                                      
                  Secretary of the                                                                                                                                                                                                                                                               
                  Interior's                                                                                                                                                                                                                                                                     
                  "Standards for                                                                                                                                                                                                                                                                 
                  Rehabilitation."                                                                                                                                                                                                                                                               
                  This letter is a                                                                                                                                                                                                                                                               
                  preliminary                                                                                                                                                                                                                                                                    
                  determination                                                                                                                                                                                                                                                                  
                  only, since a                                                                                                                                                                                                                                                                  
                  format                                                                                                                                                                                                                                                                         
                  certification of                                                                                                                                                                                                                                                               
                  rehabilitation can                                                                                                                                                                                                                                                             
                  be issued only to                                                                                                                                                                                                                                                              
                  the owner of a                                                                                                                                                                                                                                                                 
                  "certified                                                                                                                                                                                                                                                                     
                  historic                                                                                                                                                                                                                                                                       
                  structure" after                                                                                                                                                                                                                                                               
                  rehabilitation                                                                                                                                                                                                                                                                 
                  work is completed.                                                                                                                                                                                                                                                             

                  that the                                                                                                                                                                                                                                                                       
                  rehabilitation or                                                                                                                                                                                                                                                              
                  proposed                                                                                                                                                                                                                                                                       
                  rehabilitation                                                                                                                                                                                                                                                                 
                  will meet the                                                                                                                                                                                                                                                                  
                  Secretary of the                                                                                                                                                                                                                                                               
                  Interior's                                                                                                                                                                                                                                                                     
                  "Standards for                                                                                                                                                                                                                                                                 
                  Rehabilitation" if                                                                                                                                                                                                                                                             
                  the attached                                                                                                                                                                                                                                                                   
                  conditions are                                                                                                                                                                                                                                                                 
                  met.                                                                                                                                                                                                                                                                           

                  that the                                                                                                                                                                                                                                                                       
                  rehabilitation                                                                                                                                                                                                                                                                 
                  described herein                                                                                                                                                                                                                                                               
                  is not consistent                                                                                                                                                                                                                                                              
                  with the historic                                                                                                                                                                                                                                                              
                  character of the                                                                                                                                                                                                                                                               
                  property or the                                                                                                                                                                                                                                                                
                  district in which                                                                                                                                                                                                                                                              
                  it is located and                                                                                                                                                                                                                                                              
                  that the project                                                                                                                                                                                                                                                               
                  does not meet the                                                                                                                                                                                                                                                              
                  Secretary of the                                                                                                                                                                                                                                                               
                  Interior's                                                                                                                                                                                                                                                                     
                  "Standards for                                                                                                                                                                                                                                                                 
                  Rehabilitation." A                                                                                                                                                                                                                                                             
                  copy of this form                                                                                                                                                                                                                                                              
                  will be provided                                                                                                                                                                                                                                                               
                  to the Internal                                                                                                                                                                                                                                                                
                  Revenue Service.                                                                                                                                                                                                                                                               

                                                                                                                                                                                                                                                                                                 

  Date                                                                           National                                                                                                                   National Park                                                                        
                                                                                 Park Service                                                                                                               Service                                                                              
                                                                                 Authorized                                                                                                                 Office/Telephone                                                                     
                                                                                 Signature                                                                                                                  No.                                                                                  

  See Attachments                                                                                                                                                                                                                                                                                
  --------------- ------------------ --------------------- --------------------- ------------ --------------------- --------------------- --------------------- --------------------- --------------------- ------------------ --------------------- --------------------- --------------------- ------------------------

HISTORIC PRESERVATION

+----+-----------+-----+----------+------------+---------------------+
| *  |           |     | ## CERT  |            | #                   |
| *  |           |     | IFICATIO |            |                     |
|    |           |     | N APPLIC |            |                     |
|    |           |     | ATION -- |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     | **PART   |            | #                   |
| op |           |     | 2**      |            | NPS Office Use Only |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| Na |           |     |          |            |                     |
| me |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            | Project Number:     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     |          |            |                     |
| op |           |     |          |            |                     |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| A  |           |     |          |            |                     |
| dd |           |     |          |            |                     |
| re |           |     |          |            |                     |
| ss |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** |           |     |          |            |                     |
| 5. |           |     |          |            |                     |
| DE |           |     |          |            |                     |
| TA |           |     |          |            |                     |
| IL |           |     |          |            |                     |
| ED |           |     |          |            |                     |
| D  |           |     |          |            |                     |
| ES |           |     |          |            |                     |
| CR |           |     |          |            |                     |
| IP |           |     |          |            |                     |
| TI |           |     |          |            |                     |
| ON |           |     |          |            |                     |
| OF |           |     |          |            |                     |
| RE |           |     |          |            |                     |
| HA |           |     |          |            |                     |
| BI |           |     |          |            |                     |
| LI |           |     |          |            |                     |
| TA |           |     |          |            |                     |
| TI |           |     |          |            |                     |
| ON |           |     |          |            |                     |
| /  |           |     |          |            |                     |
| PR |           |     |          |            |                     |
| ES |           |     |          |            |                     |
| ER |           |     |          |            |                     |
| VA |           |     |          |            |                     |
| TI |           |     |          |            |                     |
| ON |           |     |          |            |                     |
| WO |           |     |          |            |                     |
| RK |           |     |          |            |                     |
| ** |           |     |          |            |                     |
| -- |           |     |          |            |                     |
| In |           |     |          |            |                     |
| cl |           |     |          |            |                     |
| ud |           |     |          |            |                     |
| es |           |     |          |            |                     |
| si |           |     |          |            |                     |
| te |           |     |          |            |                     |
| w  |           |     |          |            |                     |
| or |           |     |          |            |                     |
| k, |           |     |          |            |                     |
| n  |           |     |          |            |                     |
| ew |           |     |          |            |                     |
| c  |           |     |          |            |                     |
| on |           |     |          |            |                     |
| st |           |     |          |            |                     |
| ru |           |     |          |            |                     |
| ct |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n, |           |     |          |            |                     |
| al |           |     |          |            |                     |
| te |           |     |          |            |                     |
| ra |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| on |           |     |          |            |                     |
| s, |           |     |          |            |                     |
| et |           |     |          |            |                     |
| c. |           |     |          |            |                     |
| Co |           |     |          |            |                     |
| mp |           |     |          |            |                     |
| le |           |     |          |            |                     |
| te |           |     |          |            |                     |
| bl |           |     |          |            |                     |
| oc |           |     |          |            |                     |
| ks |           |     |          |            |                     |
| be |           |     |          |            |                     |
| lo |           |     |          |            |                     |
| w. |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *1 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *2 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *3 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *4 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+

HISTORIC PRESERVATION

+----+-----------+-----+----------+------------+---------------------+
| *  |           |     | ## CERT  |            | #                   |
| *  |           |     | IFICATIO |            |                     |
|    |           |     | N APPLIC |            |                     |
|    |           |     | ATION -- |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     | **PART   |            | #                   |
| op |           |     | 2**      |            | NPS Office Use Only |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| Na |           |     |          |            |                     |
| me |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            | Project Number:     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     |          |            |                     |
| op |           |     |          |            |                     |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| A  |           |     |          |            |                     |
| dd |           |     |          |            |                     |
| re |           |     |          |            |                     |
| ss |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *5 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *6 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *7 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *8 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+

HISTORIC PRESERVATION

+----+-----------+-----+----------+------------+---------------------+
| *  |           |     | ## CERT  |            | #                   |
| *  |           |     | IFICATIO |            |                     |
|    |           |     | N APPLIC |            |                     |
|    |           |     | ATION -- |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     | **PART   |            | #                   |
| op |           |     | 2**      |            | NPS Office Use Only |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| Na |           |     |          |            |                     |
| me |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            | Project Number:     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     |          |            |                     |
| op |           |     |          |            |                     |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| A  |           |     |          |            |                     |
| dd |           |     |          |            |                     |
| re |           |     |          |            |                     |
| ss |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| *  |           |     |          |            |                     |
| *9 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 10 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 11 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 12 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+

HISTORIC PRESERVATION

+----+-----------+-----+----------+------------+---------------------+
| *  |           |     | ## CERT  |            | #                   |
| *  |           |     | IFICATIO |            |                     |
|    |           |     | N APPLIC |            |                     |
|    |           |     | ATION -- |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     | **PART   |            | #                   |
| op |           |     | 2**      |            | NPS Office Use Only |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| Na |           |     |          |            |                     |
| me |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            | Project Number:     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     |          |            |                     |
| op |           |     |          |            |                     |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| A  |           |     |          |            |                     |
| dd |           |     |          |            |                     |
| re |           |     |          |            |                     |
| ss |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 13 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 14 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 15 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 16 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+

HISTORIC PRESERVATION

+----+-----------+-----+----------+------------+---------------------+
| *  |           |     | ## CERT  |            | #                   |
| *  |           |     | IFICATIO |            |                     |
|    |           |     | N APPLIC |            |                     |
|    |           |     | ATION -- |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     | **PART   |            | #                   |
| op |           |     | 2**      |            | NPS Office Use Only |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| Na |           |     |          |            |                     |
| me |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            | Project Number:     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| Pr |           |     |          |            |                     |
| op |           |     |          |            |                     |
| er |           |     |          |            |                     |
| ty |           |     |          |            |                     |
| A  |           |     |          |            |                     |
| dd |           |     |          |            |                     |
| re |           |     |          |            |                     |
| ss |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 17 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 18 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 19 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| ** | Arch      |     |          | Describe   |                     |
| Nu | itectural |     |          | work and   |                     |
| mb | feature   |     |          | impact on  |                     |
| er | **[       |     |          | existing   |                     |
| ** |    ]{.und |     |          | feature:   |                     |
|    | erline}** |     |          |            |                     |
| ** |           |     |          |            |                     |
| 20 |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    | Ap        |     |          | **     **  |                     |
|    | proximate |     |          |            |                     |
|    | Date of   |     |          |            |                     |
|    | feature   |     |          |            |                     |
|    | **[       |     |          |            |                     |
|    |    ]{.und |     |          |            |                     |
|    | erline}** |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| De |           |     |          |            |                     |
| sc |           |     |          |            |                     |
| ri |           |     |          |            |                     |
| be |           |     |          |            |                     |
| ex |           |     |          |            |                     |
| is |           |     |          |            |                     |
| ti |           |     |          |            |                     |
| ng |           |     |          |            |                     |
| f  |           |     |          |            |                     |
| ea |           |     |          |            |                     |
| tu |           |     |          |            |                     |
| re |           |     |          |            |                     |
| a  |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| i  |           |     |          |            |                     |
| ts |           |     |          |            |                     |
| co |           |     |          |            |                     |
| nd |           |     |          |            |                     |
| it |           |     |          |            |                     |
| io |           |     |          |            |                     |
| n: |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
|    |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+
| P  |           | D   |          |            |                     |
| ho |           | raw |          |            |                     |
| to |           | ing |          |            |                     |
| n  |           | no  |          |            |                     |
| o. |           | **  |          |            |                     |
| *  |           | [   |          |            |                     |
| *[ |           |     |          |            |                     |
|    |           | ]{. |          |            |                     |
|    |           | und |          |            |                     |
|  ] |           | erl |          |            |                     |
| {. |           | ine |          |            |                     |
| un |           | }** |          |            |                     |
| de |           |     |          |            |                     |
| rl |           |     |          |            |                     |
| in |           |     |          |            |                     |
| e} |           |     |          |            |                     |
| ** |           |     |          |            |                     |
+----+-----------+-----+----------+------------+---------------------+