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NPS Forth 10-900 - OMB No. 1024-0018 (Rev. 10-90) United States Department of the Interior 4 ational Park Service ational Register of Historic 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 any item does not apply to the property being documented, enter "N/A" 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 Evergreen Hill other names/site number 2. Location street & number 59449 Keria Trail ❑ not for publication city or town South Bend ❑ vicinity state Iridiana code IN —141 county St. Joseph zip code 46614 3. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act of 1986, 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 certitying otticial/ I itle Uate Indiana Department of Natural Resources State or 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 commenting or other. official State or f=ederal agency and bureau 4. National Park Service Certification I hereby certify that this 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. 13 other (explain:) Date Signature of Keeper Date of Action.