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C OMB No. 10024 -0018 NPS Form 10 -900 (Oct. 1990) ited States Department of the Interior ional Park Service National Register of Historic Places Registration Form This form is for use in nominating or requesting determinations for individual properties and districts. See instructions in How to Complete the National Register of Historic Places Registration Form (National Register Bulletin 16A). Complete each item by marking "x" in the appropriate box or by entering the information requested. If an item does not apply to the property being documented, enter "NIA" for "not applicable." For functions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. Place additional entries and narrative items on continuation sheets (NPS Form 10- 900a). Use a typewriter, word processor, or computer, to complete all items. 1. Name of Property historic name grntth 'Pp7ir3 Rrewi rr* ilissnnintinr other names /site number Zap ?t7 2. Location street & number 1636 Uncolnvralr West ❑ not for publication city or town South Bend ❑ vicinity state Indic.na code IN county St. Joseph code 141 zip code 46628 3. State: /Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this ❑ nomination ❑ request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion, the property ❑ meets ❑ does not meet the National Register criteria. I recommend that this property be considered significant ❑ nationally ❑ statewide ❑ locally. (❑ See continuation sheet for additional comments.) Signature of certifying officiallTitle State of Federal agency and bureau Date In my opinion, the property ❑ meets ❑ does not meet the National Register criteria. (❑ See continuation sheet for additional comments.) Signature of certifying officialfTitle Date State or Federal agency and bureau 4. National Park Service Certification hereby certify that the property is: Signature of the Keeper ❑ entered in the National Register. ❑ See continuation sheet. ❑ determined eligible for the National Register ❑ See continuation sheet. ❑ determined not eligible for the National Register. _ ❑removed from the National Register. ❑ other, (explain:) Date of Action