Historical 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. Thank you.

    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: