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hP~ =u~m i~'. ~i1G ~:~M& t'+r •OOe•~,i 12 ~ <br />~liL'1 t9~)`~ <br />tInltrfid Ststse ~aIL1f1elt!I of ~ Jntertur <br />Na4ior»t P'a~ Service <br />l~atlgr~$i Register of liisiorc places <br />~tegisiratlon i:orrn <br />This form iR for use m nomirtiatirtig cr requusttng tleterrr>tnat~ona for ,nCividual vr~ertiats and tiiStiiCts. Bee ir,~r;jctions •n N.ow ro ~.xnfotrite the <br />Nauerral R~esa. ~ lYlslorie P!aowt Aeglatracion Fon-r (Naticnef Register Swtetin t8A). ComplKa oath item by me-il!ttig "x" to thA app.Mariate xx or <br />by arnsnny Sne intor:^tiatton rogt<ewted. if a.~ :tam fee! hot apgfy to the p~vperty beirtig •~ocumacrtoc, 8ntw "ti/A" !w "not applk~oie." FM hsnctiortts, <br />architecture! elrsssiNeatior-, matsnais, and areas cf ~rtiiheanee, enter rx4y oat~rories and suoeattigoriee ham the inatrvetiortie. P!aCe ad~itionai <br />ertnee and narrative items on continuation ahewa (N~ Form tt}t~00e) Jse a typewriter. vw,,rJ procroscir, or ~anwter b c~~rnplete aff Karns. <br />1. ~flfe Ott PtOpefly <br />`iau~e Faucette douse <br />historc name .--_-_-- _-- -_-- -•---_-- <br />';he Llras <br />other nt3tmeslsite number _ __-- -- __--- -- <br />2. Location <br />street r~ number _ 1 ~ ~ o `i= 11 ' s__~ ii 11 Rci . <br />cic/ or town _- _ T f l a n c1 <br />` i?iot tCr ~DUiDiiCBtion <br />vlGif?ity <br />staie.`.-ortz Carolina _ code '``~ county Oranc-e _-_~_ code 135_.. zip code:~?Qi <br />9. Stete/Federe! Agency Grtifica~tlon <br />~ A~ a tns ~aeigrsted autnonty usher tM Natkx+!!t kletoric P,sservat~ Act, as amanlera. ; !+aretry crr:ify that this L rx~r.-irat!on-- <br />request for rietermtnat:on of elipibiiity mee19 the ciocumerraation stAndatds for req;stenng on.+perttes n the Nariatiai Regixx .~t <br />'tfi+nrxic Ptacets end rneeta the arncanura! ana proteasianat requirements set tor!h in 38 G+=R F3r 9D, ir. my c~in:on, rtw prt>Etierty <br />' ~ rrwets ~: doss nor :neat the Natior±ai Register cnteria.. recomrnera<f t,*tat this properPt+ b*r ~~rsdsred signiiicard <br />~ .1 rtiatiatatf} !~ statewiee -~~ iocafiy {!~ See .ont'ruation sftiae: fcr add:tionai :omn-•en».;.) <br />I Signature of certifynq officiaUTitle _____ _ .- Oats - -- <br />1 <br />~ --- - <br />~ State .x ~eoeret agun."y and Ix.reFtu - - ----- -- <br />i ~ ~-~ ~ -------° -- <br />!; , my opinion, the property ~' meets L: does ~;et meet :ne Natiohal Flegis!a er ,e•ia. + ~_ ~ See continuatia: s::eet for a :ait~:+r±a: <br />cortizents.) <br />Signature of certifying ~f+ciaf/tltls ~~ sera - <br />1 Stets or ~eCM31 agency isrrd gateau .-.-...-__.__.---.~-. _ <br />i <br />i <br />4. Nauonai Pa~c Service ~e!*tiffcation <br />I ~~eretr~ cart+'} that !!tie prorsir~ .s: Signature Ol [hB Kc~ar vs:e ~~f .ict~cr• <br />_~ snt9red ~n the ttauoriaf Regw;er <br />i 'Set ca~;tiri~afion 3heat. -._------•-•-__-- -- _ <br />~_ : aeterrhi:~ eli )~t4e Ic:r the <br />NaUrxial 46~r;istor <br />~_! See conr,ruation si`84N. _..----•-----------•-•----•-----•-------- <br />oarerrreneo not aii!~ibie f8r'he _...--- -- --- -----. - <br />M1auonal Register. <br />_ rPmlived !tom rye Natanri <br />t~Eg.ster <br />i) other, (axpfam) _....__..._.-...__ <br />i <br />----- i <br />