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Please submit all nomination information, along with this completed form, by January 8, 1999 to: <br />The National Trust for Historic Preservation Media Relations Office <br />1785 Massachusetts Avenue, NW <br />Washington, DC 20036 <br />phone - 202-588-6141 w fax - 202-588-6299 <br />Name of Site <br />Address <br />County <br />Date of Property <br />Owner Name <br />Owner Address (if different) <br />Designation (choose one) <br />O National Historic Landmark <br />O Other (explain). <br />Ownership (please choose one) O Public O Private <br />O National Register O National Register Eligible O State/L-ocal Designation - <br />Please prouide the following information on a separate document. All Questions must b& answered. Attach any <br />supporting materials, including photographs, news articles, correspondence, etc. <br />1. Provide the name of the individual (or group) nominating the site. <br />2. Provide the address and phone number of the individual(s),or-groups) nominating the site. <br />3. What is the physical description of the site? <br />4. What is the site's history? <br />S. How well known is the site? Who goes there? (tourists, school children?) Is this site open to the public? <br />6. Why is this site important? What preservation issues does it exemplify? (sprawl, inner-city decline, etc.?) <br />Please consider the following - How is the site unique? Why should anyone care that it is endangered? <br />7. What is the threat to the site? (is the threat a result of natural disaster, poor maintenance, lack of funds, etc.?) <br />8. How significant is the threat? (is the building about to fall? is the ship about to sink?) <br />9. How can the threat be eliminated? (More money, change of ownership, education, protection mechanism?) <br />10. Who are the major players? (is there a 'Friends of group, gouernment agency, private citizens?) <br />1 I.- is there any opposition to the preservation of this site? Explain. <br />12. How would listing this site as one of Americas 1 t Most Endangered Historic Places help? <br />13. Other than listing this site as endangered, what else can the National TYust do to alleviate the threat? <br />14. How has the National "IYust been involved to date? What role, if any, is there for the National 'IYust if this <br />site is put on the list of the l 1 Most Endangered Historic Places? <br />15. Provide any additional comments / recommendations. <br />16. Provide the names, titles and phone numbers of all appropriate contacts. <br />