共同的名字（ common name）.docVIP

Property Name: Street Address: Street #: Apartment #: (Low) (High) (Low) (High) Prefix: Street Name: Suffix: Type: County(s): Zip Code: Municipality(s): Block(s): Local Place Name(s): Lot(s): Ownership:: USGS Quad(s) Description: Registration and Status Dates: National Historic Landmark: SHPO Opinion: National Register: Local Designation: New Jersey Register: Other Designation: Determination of Eligibility: Other Designation Date: Photograph: 5” x 3.5” – Please mount photos as indicated. For portrait oriented photos, mount with the top to the left Survey Name: UNPROTECT DOCUMENT (toolsunprotect); ENTER APPROPRIATE INFO HERE; Date: January 25, 2001 Surveyor: CUT AND PASTE THIS TABLE AND ASSOCIATED HORIZ. LINE ABOVE INTO Organization: DOCUMENT FOOTER; Re PROTECT DOCUMENT (toolprotect document, as form) Location Map: Site Map: Bibliography/Sources: Additional Information: More Research Needed? Yes No INTENSIVE LEVEL USE ONLY Attachments Included: Building Structure Object Bridge Landscape Industry Within Historic District? Yes No Status: Key-Contributing Contributing Non-Contributing Associated Archaeological Site/Deposit? Yes (Known or potential Sites – if yes, please describe briefly)  THIS PAGE TO BE COMPLETED ONLY AT INTENSIVE LEVEL AND ONLY IF PROPERTY IS A FARM COMPLEX Historic Farm Name: Period of Agricultural Use: To Source Agriculture Type: Remaining Historic Fabric Acreage: Farm Description: History: Significance: Eligibility for New Jersey and National Registers: Yes No National Register Criteria: A B C D Level of Significance Local State National Justification of Eligibility/Ineligibility: For Historic Districts Only: Property Count: Key Contributing: Contributing: Non Contributing: For Individual Properties Only: List the completed attachments related to the property’s significanc