Plaque Application

Please complete the form to the best of your ability.  If you are not sure of an answer please enter “unknown.” All fields are required with the exception of the “comments” field. You will be contacted for confirmation and payment. The fee for each plaque is $135 plus $40 for a steel post and installation materials.

Contact Information
Name/Organization:
Address:
E-mail:
Phone:
Historical Property Information
Historic Name:
Year Built:
Number and Street:
City or Village:
Property Tax Number:
Legal Description:
Comments: