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q /3 A/Roc/RRE <br />. Rating v <br />Outstanding I�Q,SlgnlfIcant / Notable XContrlbuting <br />"" <br />2. County <br />S.T.J 05t p Ai <br />3. Survey No. <br />_ <br />. Historic Name �r <br />5. Township <br />OR-T +(\". <br />Preliminary No. <br />— . <br />. Address <br />L//3 M Vp\RRe <br />7. City <br />soork-k $•Kn <br />8. Quad Name <br />INDIANA HISTORIC SITES AND STRUCTURES INVENTORY State of Indiana Department of Natural Resources State Form 16822/Revised 1987 <br />lount Contact Prints Here <br />J. <br />c P • <br />'7y te <br />Common Name <br />10. Visible <br />igl.Yes 0 No <br />11. Endangered Explain . v, <br />0 Yes No <br />!. Ownership <br />J Public Wrivate <br />Owner's Address (If different) <br />. Use Present Past <br />)sidence la <br />)mmercial ❑ ❑ <br />❑ O <br />14. Category <br />gBullding(s) <br />131 District <br />❑site <br />0 Structure <br />0 Object <br />15. Surveys / Legal Protections <br />GP I\f R1) — Li4 D <br />16.Loocation Notes / Legal Description <br />` - <br />Y(1 xi O X 11 2. LOT 41 I <br />FAfs6N►4GNT 6 606 <br />1 S -- /o51- 2307 <br />17. Condition <br />0 Excellent <br />jgr Good <br />❑ Fair <br />❑ Deteriorated <br />0 Ruins <br />18. Integrity <br />0 Unaltered <br />❑Altered <br />❑ Moved <br />0 0 <br />Date moved <br />Time Period(s) <br />190 <br />20. style(s)/C fZAFTS M14N <br />/ Dou \rm. <br />21. Architect / Builder <br />PRE >/r4/407k f M190R y e <br />22. SPECIFY ALTERATIONS 4-1— UptQe / <br />movais <br />Replacement <br />Additions <br />Other <br />23. DESCRIPTION <br />24. SITE PLAN <br />)rise 2 t/9_. <br />n <br />l' <br />Ad <br />`� <br />if <br />- <br />`` <br />:Zi--ie. <br />► <br />d <br />160 <br />_^ _ <br />�L.:__......_ <br />N <br />1 <br />y <br />i al': <br />, . <br />in Rcr/ c?uA E. <br />undatlon B.2/C}{ <br />WS ‘"t" + 3" CLAP 3MD; 'R tJp t`4DL N1v4 E$y <br />of ASP HALT 541/0& ,.»5 RIPPED bJ1 P DeME..,S , C01JS0LE Begc1C <br />, <br />FULL.... 4tbT4 uN 1C-r / <br />-thee / %Z O N ZIA!? MIOOa SV Ppe12-T5 <br />vz iN2tC,K'/2 1400D SvpPDQTS r vJOOD S c�O. 1WST'. <br />3nings VI 1-)81- 4MG • TRIM 4-I -tpt.-1 C/Z.Q WIC) <br />1 <br />Y <br />!rlor <br />I. <br />undslOutbuildings TR'c.E; rE/YEp 1!it, 0NT yyl 12.1 b (3' Pick ET) <br />No. of Contributing Resources <br />26. No. f Non-contributing Resources <br />27. Environment <br />Areas of Significance: <br />❑ Agriculture <br />(14rchitecture <br />❑ Art <br />Commerce <br />Communications <br />-1 Community Planning <br />3 Conservation <br />2 Economics <br />Education <br />1 Engineering <br />3 Entertainment/ recreation <br />3 Ethnic heritage <br />3 Exploration / settlement <br />Health / medicine <br />Indian <br />Industry <br />Invention <br />3 Landscape architecture <br />3 Law <br />7 Literature <br />3 Military <br />3 Performing arts <br />3 Philosophy <br />3 Politics 1 government <br />3 Religion <br />3 Science <br />3 Social history <br />Transportation <br />7 Vernacular / Construction <br />3 Other <br />29. Historic Context(s) / Statement of Significance / Additional Description: <br />JMRNI MIG,ELv ATTACH NEGATIVE <br />l F1tits�}E1� Math Fi�t� 1ilKEl(Ltc14N <br />4- SQO44f . / QUELL AJNSE T'`/P& un1/0vE ENVELOPE HERE <br />DS5'610 Pay Locpl, 4\RCH-IrEG1-vg,AL. (H)P l3OUF3La VE2R1� <br />��� 144 <br />/ <br />NOTE : I9419 - 10t9oO S)W °PFry j y p p°g H- <br />30. FOR STATE OFFICE USE ONLY <br />,-O <br />w0OA "/C) • 'BACK PoRt1� j Rear- c i`7i 6)'1 <br />NR <br />/3 x Q cx,z a( /9117,- o?ax29' G <br />�( <br />sR <br />ci4 of //6/ . <br />E <br />NE <br />❑ SEE CONTINUATION SHEET <br />31. UTM <br />116E1111111N l l l l i l l <br />nformation Sources <br />>urveyor <br />as r „v <br />Affiliation <br />)4PL <br />Data <br />3/zoo5- <br />tevlsed by <br />Affiliation <br />Date <br />tevlsed by <br />Affiliation <br />Date <br />