Orange County NC Website
NPS Form 10-900 <br /> (Oct . 1990) OMB No . 10024-0018 <br /> United States Department of the Interior <br /> National Park" Service <br /> National Register of Historic Places <br /> Registration Form <br /> This form is for use in nominating or requesting determinations for individual properties and districts . See instructions In How to Complete the <br /> National Register of Historic Places Registration Form (National Register Bulletin 16A) , Complete each item by marking " x " in the appropriate box or <br /> by entering the information requested . If an item does not apply to the property being documented , enter " N/A" for " not applicable . " For functions , <br /> architectural classification , materials , and areas of significance , enter only categories and subcategories from the instructions . Place additional <br /> entries and narrative items on continuation sheets (NPS Form 10-900a) , Use a typewriter, word processor, or computer, to complete all items . <br /> 1 . Name of Property <br /> historic name _ _ Woodvi 7_ 1e i`; isc*% _ o i r• ni gt• ri rt- <br /> other names/site number <br /> 2 . Location <br /> street & number P ea s t and West sides NC 1 1 NW1 A ❑ not for publication <br /> city or town Lewiston - Woodville N / A ❑ vicinity <br /> state North Carolina code NC county B e r t i e code 015 zip code 27849 <br /> 3 . State/Federal Agency Certification <br /> As the designated authority under the National Historic Preservation Act, as amended , I hereby certify that this ❑ nomination <br /> ❑ request for determination of eligibility meets the documentation standards for registering properties in the National Register of <br /> Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60 , in my opinion , the property <br /> ❑ meets ❑ does not meet the National Register criteria. I recommend that this property be considered significant <br /> ❑ nationally ❑ statewideXX locally. ( ❑ See continuation sheet for additional comments .) <br /> Signature of certifying official/Title Date <br /> State of Federal agency and bureau j <br /> In my opinion , the property 0 meets ❑ does not meet the National Register criteria . ( ❑ See continuation sheet for additional <br /> comments . ) <br /> Signature of certifying officiaifTitle Date <br /> State or Federal agency and bureau <br /> i <br /> 4 . National Park Service Certification <br /> I hereby certify that the property Is : Signature of the Keeper Date of Action <br /> ❑ entered in the National Register, <br /> ❑ See continuation sheet. <br /> ❑ determined eligible for the <br /> National Register <br /> ❑ See continuation sheet. <br /> ❑ determined not eligible for the <br /> National Register. <br /> ❑ removed from the National <br /> Register. <br /> ❑ other, (explain , ) <br />