Wisconsin Trust for Historic Preservation

 

Nomination Application

Contact the WTHP office in Madison for an application, 608-255-0348. Or print, complete and submit the application below.

 

Wisconsin's Ten Most Endangered Historic Properties

Application Deadline: November 15, 2006

          Name of Property                                                                                                                                                                                

          Address (Location)                                                                                                                                                                              

          City                                                                                               Zip Code                                                                                        

          Owner of Property                                                                     Telephone                                                                                      

          Address                                                                                                                                                                                                

          City                                                                                               State                                    Zip code                                             

          Person submitting nomination                                                                                                  Telephone                                          

          City                                                                                               State                                    Zip code                                             

For each endangered property a contact person is needed to provide information and to keep the Wisconsin Trust for Historic Preservation apprised of changes in the property’s situation. If the person submitting the nomination will not be the contact person, please provide information for a contact.

           Name of contact person                                                                                                            Telephone                                          

          Address                                                                                                                                                                                                

          City                                                                                               State                                    Zip code                                             

Please identify status designation of historic property (Mark box for current designation of the nominated property.)

 

 National Register of Historic Places

 Register Nomination in Progress (type)

 Wisconsin Register of Historic Places

 Locally- significant (Please describe)

 Local Designation (if local, identify locality).)

 

 

Identify other issues

 Road Expansion

 Rural Gentrification

 Accessibility Requirements

Other (please explain)                                                                                                                                                                

                                                                                                                                                                                                   

Please describe the property’s present condition and factors that endanger it. including the preservation threats which you believe this property illustrates (such as abandonment. Neglect alteration, etc) please attach a concise written statement for this.

Supporting materials (news articles, etc.) enclosed. Please list number of attachments.

Are the following enclosed?                 Quality photographs        Slides

Return application to: Wisconsin Trust for Historic Preservation

23 N. Pinckney St. Suite 330, P.O. Box 2288

Madison, WI 53701-2288

 

Failure to provide complete, concise information and quality photos may prevent your nomination from being selected. Please be sure to return all pages of application.

 

 
Last modified: Thursday, May 19, 2005.