HISTORIC PRESERVATION RESOURCE IDENTIFICATION FORM

**You must have the instructions and the code sheets to complete this form.**

TYPE ALL ENTRIES:

1. PROPERTY NAME:

2. RESOURCE NAME:

3. ADDRESS:

4. CITY:

5. VICINITY:

6. COUNTY:

7. COUNTY CODE:

8. LOT:

9. BLOCK:

10. PLAT NAME:

11. SECTION:

12. TOWNSHIP:

13. RANGE:

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14. RESOURCE TYPE:

15. HISTORIC FUNCTION:

16. CURRENT FUNCTION:

17. AREA OF SIGNIFICANCE, PRIMARY:

18. AREA OF SIGNIFICANCE, SECONDARY:

19. DESCRIPTION OF SIGNIFICANCE:

20. DOCUMENTATION SOURCES:

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21. NAME OF PREPARER:

22. THEMATIC SURVEY PROJECT: PROJECT NAME:

23. DATE OF PREPARATION:

24. PHOTOGRAPHS: YEAR:

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Revised 12/01/89

BUILDING CONSTRUCTION DESCRIPTION

25. ARCHITECT/BUILDER:

26. YEAR BUILT:

27. ORIGINAL SITE? DATE MOVED:

FROM WHERE?

28. ACCESSIBLE?

29. ARCHITECTURAL STYLE:

30. FOUNDATION MATERIAL:

31. ROOF TYPE:

32. ROOF MATERIAL:

33. WALL MATERIAL, PRIMARY:

34. WALL MATERIAL, SECONDARY:

35. WINDOW TYPE:

36. WINDOW MATERIAL:

37. DOOR TYPE:

38. DOOR MATERIAL:

39. EXTERIOR FEATURES:

40. INTERIOR FEATURES:

41. DECORATIVE DETAILS:

42. CONDITION OF RESOURCE:

43. DESCRIPTION OF RESOURCE (Present & Historic):

44. COMMENTS:

45. PLACEMENT: