Application Form
St. Andrews Civic Trust
Plaque Program
APPLICATION FORM
Contact Information (Please Print)
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Name (Owner of property) Phone/Fax Number
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Mailing Address Email address
Property Information (for plaque location)
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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
Assessment Records
Census Information
Occupation of Original Owner (if known)
Other (please specify)
Historical Photo if available
Newspaper Articles
Family records/diary
Date of Construction
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:
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