Montana National Register Sign Program Application by HC120912092649


									       Montana National Register Sign Program

                                                Please indicate type of plaque:
Name of owner/applicant
                                                Type A ____ Individual or District Only, $55
                                                Type B ____ Contributing Property within a
Mailing address                                 District, $35 (two 8”x12” panels, wall mount
                                                Type C ____ Contributing Property within a
City                      State       Zip       District, $35 (one 13”x16” plaque)

Telephone (day)                                 Mounting type (for A or C plaques)
                                                   Freestanding              Wall mount

                                                If you checked freestanding, add $7 for
Email (if you prefer this form of               the bracket attachment required.
                                                With my signature, I authorize the Montana
                                                Historical Society to develop the text of an
                                                interpretive marker for the identified National
Street address for sign delivery if different   Register of Historic Places property. I agree
from mailing address (for UPS delivery)         to install the sign outdoors according to the
                                                manufacturer’s specifications upon receipt of
        Historic Property Information           it and to care for it once it is in place. I
                                                understand that in the event of a change in
                                                ownership, the sign is to remain with the
Historic Name of NRHP Property (if known)

                                                Signature of applicant and date

Address of Property                             ___ I wish to make a tax-deductible donation
                                                in addition to the cost of my sign.

                                                Send your completed and signed
                                                application to:
                                                Ellen Baumler, Sign Program Coordinator
                                                Montana Historical Society
Do not submit payment with this application.    225 North Roberts
Payment is due when you receive your sign       PO Box 201201
text for approval.                              Helena, MT 59620-1201

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