National Register of Historic Places Registration Form – Question 3

Question 3 is for State and Federal Agency Certification.  We do not need to fill this out.

3. State/Federal Agency Certification  

As the designated authority under the National Historic Preservation Act, as amended, 

I hereby certify that this        nomination  ___ request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. 

In my opinion, the property  ___  meets   ___ does not meet the National Register Criteria.  I recommend that this property be considered significant at the following
level(s) of significance:     

 ___national                  ___statewide           ___local 

Applicable National Register Criteria: 

___A             ___B           ___C           ___D