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ociation <br />fameo P perty y <br />10. Geoqraphical Data <br />Acreage of Property 2.2 <br />UTM References <br />(Place additional UTM references on a continuation sheet.) <br />1 Wilill,lllllli <br />Zone Easting Northing <br />2 (-J I I i I I I i I i I <br />Vit. Josexth County Il,' <br />County and State <br />i t 3 I_1_ l I l i l i i l l i l i l i i l <br />Zone Easting Northing <br />( 4L -J I I i I i I I i I i I i I <br />❑ See continuation sheet <br />Verbal Boundary Description <br />(Describe the boundaries of the property on a continuation sheet.) <br />Boundary Justification <br />(Explain why the boundaries were selected on a continuation sheet.) <br />11. Form Prepared By <br />name/title Glom; -June Greiff. ConsultiY,; -11istorian <br />r South Bend and St. Joseph Counter <br />organization u, c+,)ri r• are=:er ti nr Cnmrl ,Gi on date ` MTr, rch 1t34�o <br />street & number. 1757 South Talbott <br />city or town, ; a P-polls <br />Additional Documentation <br />Submit the following items with the completed form: <br />Continuation Sheets <br />Maps <br />telephone 337-c};;7-6163 <br />state IN zip code 46 �z 25 <br />A USGS map (7.5 or 15 minute series) indicating the property's location. <br />A Sketch map for historic districts and properties having large acreage or numerous resources. <br />Photographs <br />Representative black and white photographs of the property. <br />Additional items <br />(Check with the SHPO or FPO for any additional items) <br />Property Owner <br />(Complete this item at the request of SHPO or FPO.) <br />name Ethel Anderson <br />street & number <br />1636 Lincolnway hest <br />telephone <br />219-252-6360 <br />city or town <br />South Bend <br />state IP3 <br />zip code 46628 <br />Paperwork Reduction Act Statement: This information is being collected for applications to the National Register of Historic Places to nominate <br />properties for listing or determine eligibility for listing, to list properties, and to amend existing listings. Response to this request is required to obtain <br />a benefit in accordance with the National Historic Preservation Act, as amended (16 U.S.C. 470 et seq.). <br />Estimated Burden Statement: Public reporting burden for this form is estimated to average 18.1 hours per response including time for reviewing <br />instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding this burden estimate or any aspect <br />of this form to the Chief, Administrative Services Division, National Park Service, P.O. Box 37127, Washington, DC 20013-7127: and the Office of <br />Management and Budget, Paperwork Reductions Projects (1024-0018), Washington, DC 20503. <br />