<p> MONTANA HISTORIC PROPERTY RECORD For the Montana National Register of Historic Places Program and State Antiquities Database</p><p>Montana State Historic Preservation Office Montana Historical Society PO Box 201202, 1410 8th Ave Helena, MT 59620-1202</p><p>Property Address: Site Number: (An historic district number may also apply.) Historic Address (if applicable): </p><p>City/Town: County: </p><p>Historic Name: Legal Location</p><p>Original Owner(s): PM: Montana Township: Range: </p><p>Current Ownership Private Public ¼ ¼ ¼ of Section: </p><p>Current Property Name: Lot(s): </p><p>Owner(s): Block(s): </p><p>Owner Address: Addition: Year of Addition: </p><p>USGS Quad Name: Year: Phone: </p><p>Historic Use: UTM Reference www.nris.mt.gov</p><p>Current Use: NAD 27 or NAD 83(preferred) </p><p>Construction Date: Estimated Actual Zone: Easting: Northing: </p><p>Original Location Moved Date Moved: </p><p>National Register of Historic Places Date of this document: </p><p>NRHP Listing Date: Form Prepared by: </p><p>Historic District: Address: </p><p>NRHP Eligible: Yes No Daytime Phone: </p><p>MT SHPO USE ONLY Comments: Eligible for NRHP: □ yes □ no Criteria: □ A □ B □ C □ D Date: Evaluator: MONTANA HISTORIC PROPERTY RECORD PAGE 2 Architectural Description Property Name: Site Number: </p><p>ARCHITECTURAL DESCRIPTION</p><p>Architectural Style: American 4-Square If Other, specify: Property Type: Agriculture Specific Property Type: </p><p>Architect: Architectural Firm/City/State: Builder/Contractor: Company/City/State: Source of Information: </p><p>MONTANA HISTORIC PROPERTY RECORD PAGE 3 History of Property</p><p>Property Name: Site Number: </p><p>HISTORY OF PROPERTY MONTANA HISTORIC PROPERTY RECORD PAGE 4 Information Sources/Bibliography</p><p>Property Name: Site Number: </p><p>INFORMATION SOURCES/BIBLIOGRAPHY MONTANA HISTORIC PROPERTY RECORD PAGE 5 Statement of Significance</p><p>Property Name: Site Number: </p><p>NATIONAL REGISTER OF HISTORIC PLACES</p><p>NRHP Listing Date: NRHP Eligibility: Yes No Individually Contributing to Historic District Noncontributing to Historic District NRHP Criteria: A B C D Area of Significance: Period of Significance: </p><p>STATEMENT OF SIGNIFICANCE MONTANA HISTORIC PROPERTY RECORD PAGE 6 Integrity</p><p>Property Name: Site Number: </p><p>INTEGRITY (location, design, setting, materials, workmanship, feeling, association) MONTANA HISTORIC PROPERTY RECORD PAGE 7 Photographs</p><p>Property Name: Site Number: </p><p>Feature # Description: Facing: </p><p>Feature # Description: Facing: MONTANA HISTORIC PROPERTY RECORD PAGE 8 Site Map</p><p>Property Name: Site Number: MONTANA HISTORIC PROPERTY RECORD PAGE 9 Topographic Map</p><p>Property Name: Site Number: </p>