Form 10-168d HPCA State Historic Preservation Office Review & Recomme

UNITED STATES DEPARTMENT OF THE INTERIOR
NATIONAL PARK SERVICE

OMB Approved
No. 1024-0009
Form 10-168d
Revised 2/2013

Historic Preservation Certification Application
State Historic Preservation Office Review & Recommendation Sheet
Significance – Part 1

Project Number:

Number

1

Preliminary done

(Property)

(Historic District)
SHPO REVIEW SUMMARY

NR District

Certified State or Local district

Date application received by State
Date(s) additional information requested by State
Date complete information received by State
Date of transmittal to NPS
Property visited by State staff?

Number

2

Fully reviewed by SHPO
No outstanding concerns
Owner informed of SHPO recommendation
In-depth NPS review requested
Recommendation different from applicant’s request

STATE RECOMMENDATION
who meets the Secretary of the Interior’s Professional Qualification Standards, have reviewed this application.

,

The property is included within the boundaries of a registered historic district, contributes to the significance of the district, and is
a “certified historic structure” for the purpose of rehabilitation.
The property is included within the boundaries of a registered historic district, contributes to the significance of the district, and is
a “certified historic structure” for a charitable contribution for conservation purposes in accordance with the Internal Revenue
Code.
The property does not contribute to the significance of the above-named district.
Insufficient documentation has been provided to evaluate the structure.
This application is being forwarded without recommendation.
Preliminary determinations:
The property appears to meet National Register Criteria for Evaluation and will be nominated individually.
The property does not appear to meet National Register Criteria for Evaluation and will not be nominated.
The property appears to contribute to the significance of a:
potential historic district that appears to meet the National Register Criteria for Evaluation and will likely be nominated.
registered historic district but is outside the period(s) or areas of significance as documented in the National Register
nomination or district documentation on file with the NPS and nomination will be amended.
The property is located in a proposed historic district and:
the property does not appear to contribute to the significance of the proposed historic district.
The proposed historic district does not appear to meet the NR Criteria for Evaluation and will not be nominated.

Date

State Official Signature

Number

3

Number

4

ISSUES
Extensive loss or deterioration of historic fabric

Moved property

Substantial alterations over time

State recommendation inconsistent with NR documentation

Significance less than 50 years old

Functionally related complex or multiple buildings within an
individual nomination.

Obscured or covered elevation(s)

Other (explain)

Complete items below as appropriate
(1)

is the period(s) of significance of the district.

(2) The property is mentioned in the NR or state or local district documentation, Section

, Page

.

(3) For preliminary determinations, the status of the nomination for the property/historic district:
Nomination has already been submitted to State Review Board, and will be forwarded to the NPS within
months. Draft nomination is enclosed.
Nomination was submitted to NPS on
Nomination process will likely be completed within thirty months.
Other, explain:

(4)

Number

5

The property is located in a registered district, but its current condition is inconsistent with the determination of
its contribution to the district as stated in the nomination. Supplemental Listing Record requested.

Describe problematic issues or other concerns.

See attachments:

photographs

maps

other:

NPS COMMENTS

Date

National Park Service Signature

Recordkeeping Requirements The National Park Service does not require State Historic Preservation Offices to retain this form
Privacy Act And Paperwork Reduction Act Notice The information requested in this form is being collected from the State Historic Preservation Officer in order to enable the Secretary of the Interior to
gain the benefit of the State review of applications for Federal tax incentives for historic by owners of historic properties. Information collected on this form, including names and all written comments, is
subject to disclosure. Reporting burden for this form—including the time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form—is estimated to average 2.5
hours per response for Part 1; 5 hours per response for Part 2; 2.5 hours for an Amendment/Phase Advisory, and 3.5 hours per response for Part 3. Comments regarding this burden estimate or any aspect of
this form may be made to the Chief, Technical Preservation Services, National Park Service, 1201 “Eye” St., NW, Washington, D.C. 20005. A Federal agency may not conduct or sponsor, and a person is not
required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this application and has assigned it control number 1024-0009.