| OCR Text |
Show 4. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act of 1966, as amended, I hereby certify that this _X__nomination __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 CB'R Part 60. In my opinion, the property X meets __does not meet the National Register criteria. __See continuation sheet. Signature of certifying official Date UTAH.. J.TATEJglSTQR.ICjMj. SOCIETY__________________________ State or Federal agency and bureau In my opinion, the property __meets __does not criteria. See continuation sheet. ii meet the National Register Signature of commenting or other official Date State or Federal agency and bureau 5. National Park Service Certification I, hereby, certify that this property is: __. entered in the National Register. See continuation sheet \7 determined eligible for the National Register. __ See continuation sheet determined not eligible for the National Register. removed from the National Register. other, (explain:) Signature of the Keeper Date 6 . FunctIonsL or JJse________________________________________ _______ Historic Functions Current Functions (enter categories from instructions) (enter categories from instructions) DOMESTIC: single dwelling________ DOMESTIC; secondary structure____ VACANT/NOT IN USE______________ ____________________________ |
