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Application Form

St. Andrews Civic Trust
Plaque Program
APPLICATION FORM

    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

    RESEARCH INFORMATION
    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   
https://docs.google.com/file/d/0B-DRtY-xwhnIYmlLLXl1ODk3bXc/edit
  .pdf 74 KB