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Show OMB No. 10024-0018 NPS Form 10-900 (Oct. 1990) United States Department of the Interior National Park Service RECEIVED 2280 National Register of Historic Places Registration Form SEP 27200? This form is for use in nominating or requesting determinations for individual properties and distric ^ National Register of Historic Places Registration Form (National Register Bulletin 16A). Complete each item by marking "xHfTTF'ie appropriate" DOX or by entering the information requested. If an item does not apply to the property being documented, enter "N/A" for "not applicable." For functions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. Place additional entries and narrative items on continuation sheets (NPS Form 10-900a). Use a typewriter, word processor, or computer, to complete all items. 1; Name of Property historic name '^••^^•••^•••'^•''•••'i :^- '-v ; V' - ; '" /: /" ' . :-- 'J': : -'-- -.("/ : , : : -V;'-': 'v ---:-; :"'. Davis. David E.. House (amendment)______________________________ other name/site number _____________________________________________ 2, location •"/;'/- *.-[• •••;r: " - -,;.-•/• -; • ••^•••••- .'•=• ; V^.-. - • "• • "••- : : : v -..:--?'".- '/-•'•• " street name 400 East Highway 199 (also 465 East Highway 199) city or town Rush Valley (formerly Clover) state Utah code UT D not for publication vicinity county Topele code 045 zip code 84069 3. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this |3 nomination D request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion, the property E] meets D does not meet the National Register criteria. I recommend that this property be considered significant D nationally/D statewide [3 locally. ( D See conjfhuation sheet for additional comments.) Signature of certifying official/Title Date Utah Division of State History. Office of Historic Preservation State or Federal agency and bureau In my opinion, the property D meets D does not meet the National Register criteria. ( D See continuation sheet for additional comments.) Signature of certifying official/Title Date State or Federal agency and bureau 4. National Park Service Certification I hereby conify that the property is: M entered in the National Register. D See continuation sheet. D determined eligible for the National Register D See continuation sheet. D determined not eligible for the National Register. D removed from the National Register. O other, (explain:) __________ Date of Action |
