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If <br />_ C;nildr .nts Dianengary <br />Name of Property- � - <br />10. Geographical Data <br />Acreage of Property le s s than one acre <br />UTM References <br />(Place additional UTM references on a continuation sheet.) <br />► I i to1 16-11 1019 iO 1 14-1 & 111315 0,01 <br />Zone Easting Northing <br />I I � 1I <br />2 I 1 l I i t l i , l . 1 <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 />St. Josetih County IN <br />County and State <br />- <br />3 it 1 1,.111111111 <br />Zone Easting Northing <br />4! I J11.111111111 <br />E] See continuation sheet <br />name/title-.. Glory -Ju e Greiff' . Consulting Historian <br />organization <br />street & number 1753 SDtitn 1 l do .t <br />city or town IrA.i ar grni i o <br />Additional Documentation <br />Submit the following items with the completed form: <br />Continuation Sheets <br />Maps <br />telephone 317-637-61ti3 <br />state TN zip code _46225 <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 unnQPl NPi :rhhnrhnnr9 r:Pntar .. Inc. <br />street & number 1045 West 4ashinatnn telephone 19- .34-6n4l <br />cityor town South Bend state IN zip code <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 />