Form 10-934 National Historical Landmark Nomination

NATIONAL HISTORIC LANDMARK NOMINATION

NPS Form 10-934 (Rev. 07-2014) OMB Control No. 1024-0276

PROPERTY NAME Page 3

United States Department of the Interior, National Park Service National Historic Landmarks Nomination Form

1. NAME AND LOCATION OF PROPERTY

Historic Name:

Other Name/Site Number:

Street and Number (if applicable):

City/Town: County: State:

2. SIGNIFICANCE DATA

NHL Criteria:

NHL Criteria Exceptions:

NHL Theme(s):

Period(s) of Significance:

Significant Person(s) (only Criterion 2):

Cultural Affiliation (only Criterion 6):

Designer/Creator/Architect/Builder:

Historic Contexts:

Paperwork Reduction Act Statement. We are collecting this information under the authority of the Historic Sites Act of 1935 (16 U.S.C. 461-467) and 36 CFR part 65. Your response is required to obtain or retain a benefit. We will use the information you provide to evaluate properties nominated as National Historic Landmarks. 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. We estimate the time to prepare an initial inquiry letter is 2 hours, including time to maintain records, gather information, and review and submit the letter. You may send comments on the burden estimate or any other aspect of this form to the Information Collection Clearance Officer, National Park Service, 12201 Sunrise Valley Drive, Room 2C114, Mail Stop 242, Reston, VA 20192.

3. WITHHOLDING SENSITIVE INFORMATION

Does this nomination contain sensitive information that should be withheld under Section 304 of the National Historic Preservation Act?

 

___  Yes

 

___  No

4. GEOGRAPHICAL DATA

1. Acreage of Property:

2. Use either Latitude/Longitude Coordinates or the UTM system:

Latitude/Longitude Coordinates:

Datum if other than WGS84:

(enter coordinates to 6 decimal places)

Latitude: Longitude:

OR

UTM References: Zone Easting Northing

3. Verbal Boundary Description:

4. Boundary Justification:

5. SIGNIFICANCE STATEMENT AND DISCUSSION

INTRODUCTION: SUMMARY STATEMENT OF SIGNIFICANCE

PROVIDE RELEVaNT PROPERTY SPECIFIC HISTORY, HISTORICAL CONTEXT, and THEMES. Justify Criteria, EXCEPTIONS, and Periods of Significance LISTED IN SECTION 2.

6. PROPERTY DESCRIPTION AND STATEMENT OF INTEGRITY

Ownership of Property Category of Property

Private: Building(s):

Public-Local: District:

Public-State: Site:

Public-Federal: Structure:

Object:

Number of Resources within Boundary of Property:

Contributing Noncontributing

Buildings: Buildings:

Sites: Sites:

Structures: Structures:

Objects: Objects:

Total: Total:

PROVIDE PRESENT AND PAST PHYSICAL DESCRIPTIONS OF PROPERTY

(Please see specific guidance for type of resource[s] being nominated)

7. BIBLIOGRAPHICAL REFERENCES AND OTHER DOCUMENTATION

Previous documentation on file (NPS):

Previously Listed in the National Register (fill in 1 through 6 below)

__ Not previously listed in the National Register (fill in only 4, 5, and 6 below)

1. NR #:

2. Date of listing:

3. Level of significance:

4. Applicable National Register Criteria: A__ B__ C__ D__

5. Criteria Considerations (Exceptions): A__ B__ C__ D__ E__ F__ G__

6. Areas of Significance:

Previously Determined Eligible for the National Register: Date of determination:

Designated a National Historic Landmark: Date of designation:

Recorded by Historic American Buildings Survey: HABS No.

Recorded by Historic American Engineering Record: HAER No.

__ Recorded by Historic American Landscapes Survey: HALS No.

Location of additional data:

State Historic Preservation Office:

Other State Agency:

Federal Agency:

Local Government:

University:

Other (Specify Repository):

8. FORM PREPARED BY

Name/Title:

Address:

Telephone:

E-mail:

Date:

Edited by:

National Park Service

National Historic Landmarks Program

1849 C St. NW (2280)

Washington, DC 20240

Telephone: (202) 354-