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Show NPS Form 10-900 (Oct. 1990) Utah WordPerfect 5.1 Format (Revised Fab. 1993) OMB No. 10024-0018 United States Department of the Interior National Park Service National Register of Historic Places Registration Form This form is for use in nominating or requesting determinations of eligibility for individual properties or al Register of Historic Places Form (National Register Bulletin 16A). Complete each item by marking "x" in the appropriate box or by entering the information] _ 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 Culiimore. William J. and Lizzie. House other names/site number 2. Location streets number, 396 West 1600 North city or town __ Orem state Utah code UT county. N/A not for publication _____ Utah code 049 zip code. N/A vicinity 84057 3. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this ./.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 CFR Part 60. In my opinion, the property _X_meets _does not meet the National Register criteria. I recommend that this property be considered significant _nationally _statewide .XJocally. (_ See continuation sheet for additional comments.) Signature of certifying official/Title Date v A, / Utah Division of State History. Office of Historic Preservation State or Federal agency and bureau In my opinion, the property _meets _does not meet the National Register criteria. (_ See continuation sheet for additional comments.) Signature of certifying official/Title Date State or Federal agency and bureau 4. nal Park Service Certification Ihej by certify that this property is: x/entered in the National Register. _ See continuation sheet. _ determined eligible for the National Register. _ See continuation sheet. _ determined not eligible for the National Register. _ removed from the National Register. _ other, (explain:)__________ /1/s 3io/rpufey6f the Keeper/I//'Date $/A|:tion IA |
