10-900-b National Register of Historic Places Multiple Property D

NPS Form 10‑900-b OMB No. 1024‑0018

United States Department of the Interior

National Park Service

Name of Multiple Property Listing State

National Register of Historic Places Multiple Property Documentation Form

This form is used for documenting property groups relating to one or several historic contexts. See instructions in National Register Bulletin How to Complete the Multiple Property Documentation Form (formerly 16B). Complete each item by entering the requested information.

_______ New Submission ________ Amended Submission

A. Name of Multiple Property Listing

B. Associated Historic Contexts

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

C. Form Prepared by:

name/title

organization

street & number

city or town state zip code

e-mail

telephone date

D. Certification

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

_______________________________ ______________________ _________________________

Signature of certifying official Title Date

_____________________________________

State or Federal Agency or Tribal government

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

________________________________ __________________________________

Signature of the Keeper Date of Action

Table of Contents for Written Narrative

Create a Table of Contents and list the page numbers for each of these sections in the space below.

Provide narrative explanations for each of these sections on continuation sheets. In the header of each section, cite the letter, page number, and name of the multiple property listing. Refer to How to Complete the Multiple Property Documentation Form for additional guidance.

	Page Numbers
E. Statement of Historic Contexts (If more than one historic context is documented, present them in sequential order.)
F. Associated Property Types (Provide description, significance, and registration requirements.)
G. Geographical Data
H. Summary of Identification and Evaluation Methods (Discuss the methods used in developing the multiple property listing.)
I. Major Bibliographical References (List major written works and primary location of additional documentation: State Historic Preservation Office, other State agency, Federal agency, local government, university, or other, specifying repository.)

Paperwork Reduction Act Statement: This information is being collected for applications to the National Register of Historic Places to nominate properties for listing or determine eligibility for listing, to list properties, and to amend existing listings. Response to this request is required to obtain a benefit in accordance with the National Historic Preservation Act, as amended (16 U.S.C.460 et seq.). We may not conduct or sponsor and you are not required to respond to a collection of information unless it displays a currently valid OMB control number.

Estimated Burden Statement: Public reporting burden for each response using this form is estimated to be between the Tier 1 and Tier 4 levels with the estimate of the time for each tier as follows:

Tier 1 – 50 hours

Tier 2 – 100 hours

Tier 3 – 150 hours

Tier 4 – 250 hours

The above estimates include time for reviewing instructions, gathering and maintaining data, and preparing and transmitting reports. Send comments regarding these estimates or any other aspect of the requirement(s) to the Service Information Collection Clearance Officer, National Park Service, 1849 C St. NW (2605 - MS1242), Washington, DC 20240-0001