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/111% WtLt AM S-re.ssr <br />-r <br />ur <br />of <br />r0I <br />_r <br />u <br />N <br />laling <br />3utstanding °Significant / Notable °Contributing NC <br />Public <br />2. County <br />S1•. S0SZfI7I} <br />3. Survey No. <br />— <br />llstoric Name <br />5. Township <br />"YoQ AUE <br />Preliminary No. <br />ddrese <br />-7 \I\i I LLI Ki V-{ S-rg,'E.ST <br />7. City <br />Sno-r il)tnro <br />8. Clued Name <br />INDIANA HISTORIC SITES AND STRUCTURES INVENTORY State of Indiana Department Of Natural Resources State Form 16822 / Revised 1987 <br />mt Contact Prints Here <br />ommon Name <br />10. Visible <br />Yes ❑No <br />11. Endangered Explain <br />❑Yes 1 No <br />)wnershlp <br />V.PrIvete <br />Owner's Address al different) <br />Ise Present Past <br />dance 'yk, Jr` <br />imerclal 0 0 <br />❑ ❑ <br />14. Category <br />Building(s) <br />District <br />Site <br />Structure <br />0 Object <br />15. Surveys l Legal Protections <br />CP IvKt)R6- LIB) <br />18. Location Notes / Legal Descrlptlon <br />S 4 LOTIt. '-[ G <br />14,rNZ.tCK'C - 612-81VT5 <br />i Er — / O E.0— b V3& <br />17. Condition <br />❑ Excellent <br />° Good <br />J5L Fair <br />0 Deteriorated <br />0 Ruins <br />18. Integrity <br />0 Unaltered <br />Altered <br />❑ Moved <br />Date moved <br />0 CI <br />Ime Period(e) <br />1 e r14 <br />20. Styie(s) <br />Q Prf3 L E fe.o n)T <br />21. Architect / Builder <br />22. SPECIFY ALTERATIONS <br />ovals <br />Replacement <br />W INoorw/S <br />Additions <br />SI1)112 W <br />Other <br />23. DESCRIPTION <br />24. S1TE PLAN <br />es d <br />t <br />rREGT. <br />im....; <br />N <br />idation ION <br />ititnifilma <br />s p,1..vr 1 .s?Pe2. - 'PE EMASTON)E f La ksi-DNE (AWGIC. <br />ill <br />IDS T. C A tse7 . Isl�1(31._ <br />l C <br />1y <br />F£a�E <br />\ <br />j <br />es Fit 4TOnP WI SIk1 1�000 N'FTP .Po(T(; S1cs. <br />17.02cK v.11 V/000 T.oST tOtoCB_2TL CI—5 <br />Q <br />n_4r <br />/ <br />14i\PPED <br />Ings I/1 vgL.IAIL . AAA) M. No YlSl(31,E - e ri <br />STD RM wI Son- Mte v.., Lo1-4I O <br />J <br />I <br />or 1L- <br />N/A <br />1tlalOutbuildings 2 �r� fitLCJG ✓1 'l'ARa� k.1►w (\, Ulov}S <br />I — J) <br />...kI <br />' I L. L I Q h'l ST 2-S ET <br />-re wsppl.f. pco p.�-t1 <br />D. of Contrlduting Resources O <br />26. No. of Noncontributing Resources <br />27. Environment <br />Ar <br />❑ <br />❑ <br />❑ <br />ml <br />eas of Significance: <br />Agriculture <br />Architecture <br />Art <br />Commerce <br />Communications <br />Community Planning <br />Conservation <br />Economics <br />Education <br />Engineering <br />Entertainment / recreation <br />Ethnic heritage <br />Exploration / settlement <br />Health / medicine <br />Indian <br />Industry <br />Invention <br />Landscape architecture <br />Law <br />Literature <br />Military <br />Performing arts <br />Philosophy <br />Politics / government <br />Religion <br />0 <br />Science <br />Social history <br />Transportation <br />Vernacular / Construction <br />Dther <br />29. Historic Context(s) / Statement of Significance / Additional Descrlptlon: <br />ATTACH NEGATIVE <br />ENVELOPE HERE <br />• <br />jrJo r7 I h%D 00 S) /�INFi► /N 193 Z <br />30. FOR STATE OFFICE USE ONLY <br />e RtLAGP IA/ /%11 <br />NR <br />SR <br />E <br />NE <br />❑ SEE CONTINUATION SHEET <br />31. UTM <br />116E1E11111MM 1 I I I I I <br />ormet Ion Sources <br />veyor <br />,J1—C i WD <br />Affiliation <br />14P(. <br />Date <br />3ItweS' <br />ised by <br />Affiliation <br />Date <br />lead by <br />Al filiation <br />Date <br />