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1. Rating <br />❑Outstanding ❑Significant/Notable ❑ Contributing "i <br />2. County <br />,r SOS?Oc <br />3. Survey No. <br />4. Historic Name <br />5. Township <br />-P02TP\c,� <br />Preliminary No. <br />6. Address 1 �y y,.. J 3'/ ,._ <br />>C.1`) t,Ulli.`,' ( r„o.yalr;� <br />7. City <br />SoV[}} - 7. <br />8. Quad Name <br />INDIANA HISTORIC SITES AND STRUCTURES INVENTORY <br />State of Indiana Department Of Natural Resources State Form te822/ Revised 1987 <br />Mount Contact Prints Here <br />, <br />i. <br />9. Common Name <br />10. Visible <br />0.Yes ❑No <br />11. Endangered Explain , <br />❑Yes 21No <br />12. Ownership <br />❑Public 0 Private <br />Owner's Address (if different) <br />13. Use Present Past <br />Residence 0 0 <br />Commercial 0 0 <br />❑ 0 <br />14. Category <br />0 Bullding(s) <br />❑ District <br />0 Site <br />15. Surveys / Legal Protections <br />I` <br />C (� 1'tP'i (-� L. I - ,_..4/❑Excellent <br />NR1) <br />16. Location Notes I Legal Description <br />,5ti;"b'LoT10 S42'6r3D <br />LOT I c,i.^pih PI^W <br />olo �`L <br />' % 0 17 r t. <br />17. Condition <br />o Good <br />10 Fair <br />❑ Deteriorated <br />0 Ruins <br />18. Integrity <br />0 Unaltered <br />O Altered <br />0 Moved <br />Date moved <br />❑ ❑ <br />0 Structure <br />0 Object <br />19. Time Period(s) <br />iC12.�-- <br />20. Style(s) <br />A�' I 1CY:• ,' .,61V /Cr/An-S.MAt- <br />21. rchitect / Builder <br />/Mlt)\„JE I--RuY/Pg/II R1= <br />22. SPECIFY ALTERATIONS <br />Removals <br />• <br />Replacement <br />Additions <br />Other <br />23. DESCRIPTION <br />24. SITE PLAN <br />Stories - <br />* <br />wl <br />Plan <br />Foundation I <br />_ <br />-, <br />'.'''''', 1: <br />��1 <br />Walls - <br />Roof 11 1 - . I 1 , <br />Porches I ._ ,. I ' . _. v.l (P1 i4 .'Y' rt %.).-1' <br />r - <br />V- <br />Di <br />`I, <br />Openings 1/i r T(z.is--I (COViSQ.S..V ?\ <br />J <br />II <br />L� <br />Interior . <br />Grounds / Outbuildings <br />i <br />LAr1�n.,r -rF i2.r-.. <br />25. No. of Contributing Resources <br />26. No. of Noncontributing Resources <br />27. Environment <br />28. Areas of Significance: <br />❑ Agriculture <br />0 Architecture <br />❑ Art <br />0 Commerce <br />❑ Communications <br />O Community Planning <br />❑Conearvetion <br />❑ Economics <br />❑ EducationTt} <br />Engineering <br />Engineering 0 <br />❑ Entertainment/recreation <br />O Ethnic heritage <br />❑ Exploration / settlement <br />❑ Health 1 medicine <br />❑ Indian <br />❑ Industry <br />❑ Invention <br />❑ Landscape architecture <br />❑ Law <br />❑ Literature <br />0 Military <br />❑ Performing arts <br />0 Philosophy <br />❑ Politics) government <br />0 Religion <br />❑ Science <br />O Social history <br />0 Transportation <br />❑ Vernacular / Construction <br />❑ Other <br />29. Historic Context(s)/Statement of Significance/Additional Description: <br />ATTACH NEGATIVE <br />�k.tS APROQE(LTY WAL PART' O F EAWA." .1, c1{jp1 NtS ENVELOPE HERE <br />rjVESO i Vic' O N O F 141S rATHIC S �CTI]. C E. fiNT> ►��t �tTtON OF <br />IT To THE CIT`1 OF GOUV1k V.Ej3O 1N 1890. TIRE"PLAY' TwocVMYNxt <br />USTS f.-,QL. v-V0MiE L• CA{RPl1J P C. T-R-E OLA/NE@ bF LaTc 9 tl0 <br />RlJr, WBF' T> .99'PILF OF LAT B. TlkE 1IOUS7: N145 /40T <br />CONGT2UGTF- UNTIL /q 22a MOST LIKELY FOE 1NC.oart.E, 1 ts.W-srm-fiir <br />TUKPOSet. <br />' <br />30. FOR STATE OFFICE USE ONLY <br />NR <br />SR <br />E <br />NE <br />O SEE CONTINUATION SHEET <br />31. UTM <br />11eM11 <br />1 1 1 1 1 1: 1 1 1 1 1 <br />1 <br />32. Information Sources <br />I890 P-arr o Cj{ 1N 'PLPt E 1ST f{CAtTro.3 <br />33. Surveyor •Affiliation <br />S Sc-hkrJi rr / \A1 1,00L1 rrt_E. <br />14PC.,3I200 <br />Date <br />` <br />34. Revised by <br />Affiliation <br />Date <br />35. Revised by <br />Affiliation <br />Date <br />