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NPS Form 10-900 OMB No. 10024 -0018 (Oct. 1990) Z ted 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 by Prt —AP. S I'1 a Fri rm other names/site number 2. Location street & number 51387 Portatre Road city or town South . Bend state Indiana code IN _ county St. JoselDh 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 official/Title State of Federal agency and bureau In my opinion, the property ❑ meets ❑ does not meet the National Register criteria. (❑ See continuation sheet for additional comments.) Signature of certifying official/Title Date Date ❑ not for publication ® vicinity code 141 zip code 46628 State or Federal agency and bureau 4. National Park Service Certification I hereby certify that the property is: ❑ 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:) Signature of the Keeper Date of Action