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Please cut and paste and complete as much as you can of this form to apply for historic house status to the best of your ability.

Historic Home Owner Application

Please complete this form for historic house status and return it to us via eMail to CMSMuseum@aol.com.

Please take as much space as you'd like or attach additional pages and photos (particularly historic photos!)

Present Owner
Address
Use of Building
Date of Structure
Source of information
Original Owner
Source of information
Subsequent Owners
Source of information
Significance of Structure	_____ Age _______ Architecture _______ History
Discussion of above checked categories
Structural Alterations
Research / Submission by
Date
Email Address
Mailing Address
Additional Comments or Points of Interest
	Thanks for sharing your house with us!