Historic Plaque Program Application Fields marked with an asterisk are required. Please don't skip them. Step 1 of 5 20% Applicant InformationName of Applicant* First Last Address of Applicant* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone # of Applicant*Email of Applicant* Enter Email Confirm Email Are you the owner of the property?* Yes No Owner InformationName of Owner* First Last Address of Owner* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone # of Owner*Email of Owner Enter Email Confirm Email Candidate Property InformationMunicipality*Adamstown BoroughAkron BoroughBart TownshipBrecknock TownshipCaernarvon TownshipChristiana BoroughClay TownshipColerain TownshipColumbia BoroughConestoga TownshipConoy TownshipDenver BoroughDrumore TownshipEarl TownshipEast Cocalico TownshipEast Donegal TownshipEast Drumore TownshipEast Earl TownshipEast Hempfield TownshipEast Lampeter TownshipEast Petersburg BoroughEden TownshipElizabeth TownshipElizabethtown BoroughEphrata BoroughEphrata TownshipFulton TownshipLancaster CityLancaster TownshipLeacock TownshipLititz BoroughLittle Britain TownshipLower Mount Joy TownshipManheim BoroughManheim TownshipManor TownshipMarietta BoroughMartic TownshipMillersville BoroughMount Joy BoroughMountville BoroughNew Holland BoroughParadise TownshipPenn TownshipPequea TownshipProvidence TownshipQuarryville BoroughRapho TownshipSadsbury TownshipSalisbury TownshipStrasburg BoroughStrasburg TownshipTerre Hill BoroughUpper Leacock TownshipUpper Mount Joy TownshipWarwick TownshipWest Cocalico TownshipWest Donegal TownshipWest Earl TownshipWest Hempfield TownshipWest Lampeter TownshipHistoric Name of Property Please provide background information about the candidate property*(Tell us why this particular property should be considered as a candidate for an Historic Plaque)Address of Candidate Property* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Construction Date of Candidate Property*(approximate if unknown) Name of architect/builder (if available) Name of significant person(s) associated with structure Original Use Present Use Name of significant event(s) associated with structure Significant or outstanding exterior detailsInformation about significance of structureSource of this information:(we may ask for copies of source material) AttachmentsPlease attach the following: Photographs of exterior Floor plans (sketch plans of each floor) Research (historical documentation) Attachments Drop files here or Select files Accepted file types: doc, docx, gif, jpg, jpeg, pdf, png, Max. file size: 3 MB, Max. files: 12. Non-Refundable Application Fee - $50Historic Plaque Application Fee*(non-refundable)Total $0.00 Credit Card DetailsCard Details Cardholder Name EmailThis field is for validation purposes and should be left unchanged.
