No:     

Street:     

House Name:     

Historic Plaque:   N  

Owner Info:     

Built:     

Sec:     

Subdivision:     

Lot:     

Architect:     

Cont/build:     

Description:     

Owners:     

Original Use:     

Current Use:     

As Built:     

Added To:     

Subtracted From:     

Replaced:     

Description Of Changes: