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.st. Casimir Parish Historic District co,ntyJoseand i)h County TN Name of Property 10. Geographical Data Acreage of Property 93.5 UTM References (Place additional UTM references on a continuation sheet.) iI I I I I I] I I� I I I l I I l 1 3 1 1 1 1 1 1 1 1 1 1 1 1 1 Zone Easting Northing Zone Easting Northing 2W IIIIIIII1111111 4 W I I I I I I I I I I I I I ❑ See continuation sheet Verbal Boundary Description (Describe the boundaries of the property on a continuation sheet.) Boundary Justification (Explain why the boundaries were selected on a continuation sheet.) 11. Form Prepared By name/title ('1= n7-y–June Gra-U4,, Consizlt'ing Hi storl on for Historic Pre: servatiorn Commission of organization Soi3th Rend Rn St.josel)h Countl date 4 g r11 996- street & number I TS3 g�,,th rPQI hoti: . city or town--Tncl3.an.a pol J Additional Documentation Submit the following items with the completed form: Continuation Sheets Maps . telephone 317-637-61 - state TN zip code -fa22- 6 A USGS map (7.5 or 15 minute series) indicating the property's location. A Sketch map for historic districts and properties having large acreage or numerous resources. Photographs Representative black and white photographs of the property. Additional items (Check with the SHPO or FPO for any additional items) Property Owner (Complete this item at the request of SHPO or FPO.) name street & number city or town state telephone zip code �J Paperwork Reduction Act Statement: This information is being collected for applications to the National Register of Historic Places to nominate properties for listing or determine eligibility for listing, to list properties, and to amend existing listings. Response to this request is required to obtain a benefit in accordance with the National Historic Preservation Act, as amended (16 U.S.C. 470 et seq.). Estimated Burden Statement: Public reporting burden for this form is estimated to average 16.1 hours per response including time for reviewing instructions, gathering and maintaining data, and completing and reviewing the form. Direct comments regarding this burden estimate or any aspect of this form to the Chief, Administrative Services Division, National Park Service, P.O. Box 37127, Washington, DC 20013.7127; and the Office of Management and Budget, Paperwork Reductions Projects (10240016), Washington, DC 20503.