HistoricPropertyRecord form MT SHPO

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HistoricPropertyRecord form MT SHPO Powered By Docstoc
					                         MONTANA HISTORIC PROPERTY RECORD
                 For the Montana National Register of Historic Places Program and State Antiquities Database

                                                 Montana State Historic Preservation Office
                                                       Montana Historical Society
                                                      PO Box 201202, 1410 8th Ave
                                                        Helena, MT 59620-1202



Property Address:                                                       Site Number: 24
                                                                        (An historic district number may also apply.)
Historic Address (if applicable):

City/Town:                                                              County:


Historic Name:                                                          Legal Location

Original Owner(s):                                                      PM: Montana         Township:                   Range:

Current Ownership          Private       Public                                   ¼           ¼            ¼ of Section:

Current Property Name:                                                  Lot(s):

Owner(s):                                                               Block(s):

Owner Address:                                                          Addition:                 Year of Addition:

                                                                        USGS Quad Name:                     Year:
Phone:

Historic Use:                                                           UTM Reference              www.nris.mt.gov/topofinder2

Current Use:                                                               NAD 27 or          NAD 83(preferred)

Construction Date:                   Estimated         Actual           Zone:         Easting:             Northing:

   Original Location         Moved Date Moved:


National Register of Historic Places                                    Date of this document:

NRHP Listing Date:                                                      Form Prepared by:

Historic District:                                                      Address:

NRHP Eligible:       Yes       No                                       Daytime Phone:


MT SHPO USE ONLY                                                        Comments:
Eligible for NRHP: □ yes □ no
Criteria: □ A □ B □ C □ D
Date:
Evaluator:
                               MONTANA HISTORIC PROPERTY RECORD
                                                             PAGE 2
Property Name:                                                                     Site Number: 24

ARCHITECTURAL DESCRIPTION                                                                         See Additional Information Page

Architectural Style: American 4-Square      If Other, specify:
Property Type: Agriculture     Specific Property Type:

Architect:          Architectural Firm/City/State:
Builder/Contractor:          Company/City/State:
Source of Information:

Concisely, accurately, and completely describe the property and alterations with dates. Number the buildings and features to
correlate with the Site Map.
                      MONTANA HISTORIC PROPERTY RECORD
                                   PAGE 3
Property Name:                                 Site Number: 24

HISTORY OF PROPERTY                                        See Additional Information Page




INFORMATION SOURCES/BIBLIOGRAPHY                           See Additional Information Page
                                 MONTANA HISTORIC PROPERTY RECORD
                                                           PAGE 4
Property Name:                                                                  Site Number: 24


NATIONAL REGISTER OF HISTORIC PLACES

NRHP Listing Date:
NRHP Eligibility:     Yes   No      Individually     Contributing to Historic District    Noncontributing to Historic District
NRHP Criteria:      A     B    C       D
Area of Significance:        Period of Significance:

STATEMENT OF SIGNIFICANCE                                                                    See Additional Information Page




INTEGRITY (location, design, setting, materials, workmanship, feeling, association)          See Additional Information Page
                 MONTANA HISTORIC PROPERTY RECORD
                      ADDITIONAL INFORMATION PAGE
Property Name:                                 Site Number: 24
                 MONTANA HISTORIC PROPERTY RECORD
                            PHOTOGRAPHS
Property Name:                                      Site Number: 24




                           3x5” or 4x6” color or B&W photo




Roll #
Frame #
Feature #
Facing:
Description:




                            3x5” or 4x6” color or B&W photo here




Roll #
Frame #
Feature #
Facing:
Description:
                                 MONTANA HISTORIC PROPERTY RECORD
                                                          SITE MAP
Property Name:                                                                  Site Number: 24




                 Sketch a map of the property. Label and/or number buildings and described features.
                 Include a North arrow, street names, and property boundaries.
                                 MONTANA HISTORIC PROPERTY RECORD
                                                     TOPOGRAPHIC MAP
Property Name:                                                                    Site Number: 24




                 USGS Topographic Quadrangle, 1:24,000 scale. Do not reduce or enlarge map; keep the
                 map scale accurate because legal locations are checked with a plastic template. Label the
                 property location, including the SITS number, in a method that will photocopy well. A
                 highlighter marker is not acceptable.

				
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posted:8/31/2012
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