CHC B&W Header
  1. Name of Proposed Building or site:
  1. Owner's name, address, phone and fax, to be awarded:
  1. Name, title address, phone, etc. of person to contact for further information on nomination:
  1. Significance of building or site and date of first construction or use:
  1. Building's original function (e.g., courthouse, church, business, hotel, home):
  1. How the building or site is being used today, and why it should receive recognition:
  1. Original architect, and/or builder's name, and architectural style:
  1. Date(s) of restoration (write or send details in an email under separate cover):
  1. Name, addresses, phone, fax, or architect/contractor responsible for the restoration:
  1. Awards and Landmark status the building has received:
  1. IMPORTANT: Attach history and other pertinent information
    (in duplicate, please) that would recommend this nomination
  1. Name, address, phone, fax, of CHC member suggesting this award.