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N R H P Li st e d D at e: 4 /1 2 / 2 0 2 1 N P S F or m 1 0 -9 0 0 1 0 2 4 -0 0 1 8 U nit e d St at e s D e p art m e nt of t h e I nt eri or N ati o n al P ar k S er vi c e O M B N o. N ati o n al R e gi st er of Hi st ori c Pl a c e s R e gi str ati o n F or m T his f or m is f or us e i n n o mi n ati n g or r e q u esti n g d et er mi n ati o ns f or i n di vi d u al pr o p erti es a n d distri cts. S e e i nstr u cti o ns i n N ati o n al R e gist er B ull eti n, H o w t o C o m pl et e t h e N ati o n al R e gist er of Hist ori c Pl a c es R e gistr ati o n F or m. If a n y it e m d o es n ot a p pl y t o t h e pr o p ert y b ei n g d o c u m e nt e d, e nt er " N/ A " f or " n ot a p pli c a bl e. " F or f u n cti o ns, ar c hit e ct ur al cl assifi c ati o n, m at eri als, a n d ar e as of si g nifi c a n c e, e nt er o nl y c at e g ori es a n d s u b c at e g ori es fr o m t h e i nstr u cti o ns. 1. N a m e of P r o p e rt y H ist ori c n a m e: B e all, B urt c h W., Jr., a n d S us a n, H o us e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Ot h er n a m es/sit e n u m b er: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ N a m e of r el at e d m ulti pl e pr o p ert y listi n g: N/ A _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ( E nt er " N/ A " if pr o p ert y is n ot p art of a m ulti pl e pr o p ert y listi n g ____________________________________________________________________________ 2. L o c ati o n S tr e et & n u m b er: 4 6 4 4 S. Br o o k w o o d Cir cl e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Cit y or t o w n: Mill cr e e k _ _ _ _ S t at e: U T _ _ _ _ _ _ _ _ _ _ C o u nt y: S alt L a k e _ _ _ _ N ot F or P u bli c ati o n: Vi ci nit y: ____________________________________________________________________________ 3. St at e/ F e d e r al A g e n c y C e rtifi c ati o n As t h e d esi g n at e d a ut h orit y u n d er t h e N ati o n al Hist ori c Pr es er v ati o n A ct, as a m e n d e d, I h er e b y c ertif y t h at t his X n o mi n ati o n _ _ _ r e q u est f or d et er mi n ati o n of eli gi bilit y m e ets t h e d o c u m e nt ati o n st a n d ar ds f or r e gist eri n g pr o p erti es i n t h e N ati o n al R e gist er of Hist ori c Pl a c es a n d m e ets t h e pr o c e d ur al a n d pr of essi o n al r e q uir e m e nts s et f ort h i n 3 6 C F R P art 6 0. I n m y o pi ni o n, t h e pr o p ert y _ X _ m e ets _ _ _ d o es n ot m e et t h e N ati o n al R e gist er Crit eri a. I r e c o m m e n d t h at t his pr o p ert y b e c o nsi d er e d si g nifi c a nt at t h e f oll o wi n g l e v el(s) of si g nifi c a n c e: _ _ _ n ati o n al _ _ _st at e wi d e A p pli c a bl e N ati o n al R e gist er Crit eri a: ___ A _ X__ B _X _ C _ X _ _l o c al ___ D / D e p ut y S H P O Si g n at u r e of c e rtif yi n g offi ci al/ Titl e: 2/ 1 8/ 2 0 2 1 D at e _ Ut a h Di visi o n of St at e Hist or y/ Offi c e of Hist ori c Pr es er v ati o n _ _ _ _ _ _ _ _ _ _ _ _ St at e o r F e d e r al a g e n c y/ b u r e a u o r T ri b al G o v e r n m e nt 1