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DocuSign Envelope ID: 16F7E188 -42F5- 4144- AF1B- 934E4ACOFE59 <br />131 <br />OFFICE OF STATE ARCHAEOLOGY USE <br />National Register Status <br />❑ Determined Eligible <br />❑ Placed on the Study List <br />❑ Approved for Nomination by NRAC <br />❑ Currently listed on NRHP <br />❑ Removed from NRHP <br />❑ Not eligible after evaluation <br />❑ Unassessed <br />❑ North Carolina Archaeological Record Program <br />Form reliability <br />❑ Complete <br />❑ Incomplete <br />Unreliable <br />Form Checked by <br />Date <br />Criterion <br />❑A ❑B ❑C ❑D <br />Date listed <br />Locational reliability <br />❑ Accurate <br />❑ Unknown <br />Unreliable <br />❑ Within 100 meter radius <br />❑ Within 500 meter radius <br />❑ Within 1 km radius <br />Please mail completed form, map and any photographic attachments to: <br />Susan Myers <br />Site Registrar <br />Office of State Archaeology <br />4619 Mail Service Center <br />Raleigh, NC 27699 -4619 <br />Please contact Susan Myers (susan.myers @ncdcr.gov, 919/807 -6556) or Sam Franklin, GIS Specialist <br />(samuel.franklin @ncdcr.gov, 919/807 -6563) with any questions. <br />4 <br />