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Application Form

St. Andrews Civic Trust
Plaque Program

    Contact Information (Please Print)

        Name (Owner of property)                                                       Phone/Fax Number

        Mailing Address                                                                       Email address

     Property Information (for plaque location)

       Address (if different from mailing address

    The process of researching and gathering information about your home can be very rewarding experience. The information is important for you as the building owner and St. Andrews Civic Trust. It is essential to complete the application as fully as possible. Below is a list of the information required.
        Please check items enclosed, copies only - NO ORIGINALS        
Current Photo
Historical Photo if available
Assessment Records
Newspaper Articles
Census Information
Family records/diary
Occupation of Original Owner (if known)
Date of Construction
Other (please specify)

I/we the undersigned here by authorize the St. Andrews Civic Trust to retain all records submitted with this application and permit them to use the historical information on this property to promote conservation, or our heritage. I agree to mount the plaque on the building and understand that the plaque is a fixture for the community and should remain in the event the property is sold.

        Applicant/Owner Signature(s):                                                        Date:


   Click on red square to download a copy of the Application Form
  .pdf 74 KB