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

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:

________________________ ________________________


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