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3Z M421('Esr] <br />1. Rating <br />❑Outstanding ❑Significant / Notable ❑Contributing <br />2. County <br />• 3 ds a Phi <br />3. Survey No. <br />4. Historic Name <br />5. Township <br />'PoQTACA' <br />Preliminary No. <br />6.Address325'_32T� MR2)O►J �W£sT7 <br />7CltyStyA BF�ta� <br />8.QuadName <br />INDIANA HISTORIC SITES AND STRUCTURES INVENTORY <br />State of Indiana Department of Natural Resources State Form 18822/ Revised 1987 <br />Mount Contact Prints Here <br />v A ` p ,.. e : <br />ts> <br />T <br />9. Common Name <br />PgiC )K'S PLACE- <br />10. Visible <br />yes ❑No <br />11. Endangered��``Explain <br />❑Yes to <br />12. Ownership <br />❑ Public ❑ Private <br />Owner's Address (If different) / `� <br />13. Use Present Past <br />Residence ❑ 0 <br />Commercial �, I"'District <br />❑ ❑ <br />14.�Category <br />. Buliding(s) <br />❑ Site <br />15. Surveys <br />^/Legal Protections <br />ChAPin f a�J`��j R{ j4 <br />1 LA' 1:) <br />18. Location Notes / Legal Description <br />-* S3 ex SVE Coe FOe. <br />SYCLICOT aErjetcle...t. Gyuplorc <br />17. Condition <br />0 Excellent <br />❑ Good <br />pl,fair <br />18. Integrity <br />0 Unaltered <br />3E1 Altered 11 r1-1,00- <br />❑ Moved <br />0 0 <br />0 Structure <br />- <br />/(5-1 <br />0 Deteriorated <br />Date moved <br />❑ Object <br />j q - / o 2.0 O <br />❑ Ruins <br />19. Time Period(s) <br />l4! g`-7 / (96- 8; /9 6 0 <br />20. Style(s) Zi se- Contury._ <br />111AL1AIa, -r CounlE2c1Rt,/ eon..MK.QCrm... <br />21. Architect / Builder <br />2 . SPECIFY ALTERATIONS <br />Removals <br />• <br />Replacement <br />W)A )DOD/Syr/ACT P4.asg. ps.moS' <br />Additions <br />sroee Fil vroN PO/f174e3Rc C <br />Other <br />e- I13z Affie sSos..s.) <br />23. DESCRIPTION <br />9a SITE PLAN <br />Stories o?-5+oQY ; i-'S+0r3 Rclol�-1'r.6y.� b8*C l?DQ�'AorE; ToQsg2111 <br />N <br />Plan REGCRt-lesO.A� 1 <br />Foundation i324C1C. <br />Walls MAS DW12/ - 13(GCK <br />r' <br />Roof "13¢ACf<VI I> COIl,n)tr-e STEAPep pie.APEr LuALt- FLAT <br />i l <br />Porches <br />I. <br />Openings Sc�,M 1141. l�ucti�F3R�oeeetS o� FGobTi 6Abp�(Gh t4.itlrypowS <br />AWIJ(Nap1: CovIER_ iTRF{Nc6/w/b1006,as oN ys icr0Rectsce erit <br />1 <br />Interior <br />- <br />_. <br />Grounds/Outbuildings : 5a4eOVNDor) By 2'111�lZ 1A)C.,, t,OTS j -PL.Ki1ire .5 <br />C o(LNe2 of PoleTt44,E 4- MA 2i o1.7 • itzIL.L.RBoAILt ON I- MIL)/ <br />I25. No. of Contributing Resources <br />26. No. of Non-contributing Resources <br />27. Environment <br />28. Areas of Significance: <br />0 Agriculture <br />0 Architecture <br />0 Art <br />❑ Commerce <br />❑ Communications <br />0 Community Planning <br />❑ Conservation <br />0 Economics <br />0 Education <br />0 Engineering <br />0 Entertainment / recreation <br />0 Ethnic heritage <br />❑ Exploration / settlement <br />0 Health / medicine <br />0 Indian <br />0 Industry <br />0 Invention <br />0 Landscape architecture <br />❑ Law <br />0 Literature <br />o Military <br />0 Performing arts <br />0 Philosophy <br />❑ Politics / government <br />❑ Religion <br />0 Science <br />❑ Social history <br />❑ Transportation <br />0 Vernacular/Construction <br />0 Other <br />29. Historic Context(s) / Statement of Significance / Additional Description: <br />ATTACH NEGATIVE <br />ENVELOPE HERE <br />FIZeD 4- AtL 14A(2.TM.l1 p. 3v) L.T o*c. srOR.y Li ("t'2. STO4.E - I q s7 -11 ST <br />ier or0 at'FAA- of <br />/9 ceo- ADn CUT ci- j)6 WALL.. M3p1r oN ZMN7 <br />8t161 NAL /TALIANATE srD6B "'toot" Ciq S8%) <br />ADTe : 1132 -- 1 etc,, 2 - sroty Faui w7Q4 <br />30. FOR STATE OFFICE USE ONLY <br />S.S`r - COW-14E4AGL AL. ; Ztrui - :lAtr:• LNT; l)QL- <br />NR <br />IRsooz.. oYE), ?Da..e.4k j SAO / AR.. &E (1.1261) <br />SR <br />/9yG - eneiooad porG+.; /oval sewn" •floor ortr gcoc,tc <br />E <br />1�1S$- COnO&. -8 .2I r i t bl ' Co'..e.Lere BL-ocK PrDbtTIO1) <br />NE <br />❑ SEE CONTINUATION SHEET - RE et. 6Tb 2 E <br />31. UTM <br />11s1•1 1 1 1 1 1 t l l l 1 1 <br />I <br />32. Information Sources 932 <br />1 <br />P DRT ei A66-666adS CJ44../X <br />33. Surveyor ILA W <br />J <br />Affiliation <br />14 P G <br />Date <br />3 J toes <br />34. Revised by <br />Affiliation <br />Date <br />'_5. Revised by <br />Affiliation <br />Date <br />