* IMPORTANT * Please COMPLETELY read these important instructions before typing in your information into this form. You are able to type directly into this form. To actually SAVE the document you must have Adobe Acrobat Standard or Adobe Acrobat Professional. If you only have Adobe Acrobat Reader (the free version available at www.adobe.com) you will NOT be able to save the information you type in. You MUST print it out BEFORE closing or you will lose your information. If you have the basic reader you can still use this form if you choose. We suggest that first you print out a hard copy and write in your final answers by hand. You may then go to this form and type in your answers. (Remember, you will NOT be able to save your document unless you have the upgraded Adobe Acrobat.) You may choose to either fill this form in electronically or print out a hard copy and either type or handwrite you answers. All will be accepted. If you would like this in MS Word, please notify Erin Tobin or Tania Werbizky.
If you have any questions with using this form, please contact the Preservation League, (518) 462-5658 x12 for Erin or (607) 2726510 for Tania.
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State
Seven To Save Endangered Properties Program 2009 Postmark Deadline: September 26, 2008
Date: _____________________
Nominating Organization/Agency: Check one: 501(c)(3) Unincorporated Group Government Agency Other (please explain):___________________________________________________ _____________________________________________________________________ For Organizations: Year Founded: ____________ Current Membership: __________ Contact Person/Title:___________________________________________________ Address: _____________________________________________________________ _____________________________________________________________________ Telephone: (Day) __________________________ (Eve.) ______________________ (Fax )___________________ E-mail:_______________________________________ Property Owner: ______________________________________________________ Contact Name:_________________________________________________________ Address:______________________________________________________________ _____________________________________________________________________ Telephone: (Day) _____________________ (Eve.) ________________ Is the property owner aware of this nomination?
Yes
No
Property Name: ________________________________________________________ Address: ______________________________________________________________ _____________________________________________________________________ County: ______________________________________________________________ Political Districts Property is located in: NYS Senate District No.: ________
Senator: ________________________________
NYS Assembly District No.: _______ Assemblyman/woman: _____________________ US Congressional District No.: ______ US Representative:______________________
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 2
Physical Condition: Construction Date(s): _________________________________ Excellent Good Fair Poor Is this information based on a professional assessment? Explain:
Yes
No
Historic Designation (Check all that apply and please send one copy of the nomination form): National Historic Landmark National Register New York State Register Local Designation National Register Eligible (as determined by NYSOPRHP – include official letter) Other (please explain)
1. Briefly state the property’s historic and/or architectural significance. ***Special Note: This section must include how the property relates to this year’s special theme commemorating the voyages of Henry Hudson, Robert Fulton, and Samuel de Champlain. This should also tie to the themes of exploration, settlement and commerce of the Hudson and Champlain Valleys, as related to the waterways, or associated with Robert Fulton’s steamship voyage up the Hudson from NYC to Albany.
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 3
2. Explain the importance of the property to the community (use, cultural significance, location).
3. How is this property threatened? (i.e., abandonment, inappropriate development, demolition, loss of visual and architectural integrity, etc.)
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 4
4. How would you define a “save?” (Please be specific)
5. a. Who are the stakeholders and community members who are willing to help in the property’s preservation?
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 5
5. b. What local or regional preservation organization(s) have you contacted or are working with? Please identify groups and individuals and what roles they are playing.
c. Please identify any New York State Office of Parks, Recreation and Historic Preservation staff you have contacted about the threat. What has been the response?
6. Please identify any organizations, municipal offices or business interests opposed to the property’s preservation.
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 6
7. What role have you and/or has your group played thus far in addressing the threat?
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org
Preservation League of New York State - Seven to Save-2009 Nomination
Page 7
8. List the actions you think the League could take to help alleviate the threat. (Please be specific.)
Please include any letters of support for this nomination from organizations, agencies or individuals working with you to save this property.
44 Central Avenue, Albany, NY 12206 518-462-5658
518-462-5684 (fax)
[email protected]
www.preservenys.org