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59 <br /> Nar*&,31 P(C*fKKY (1--axia, <br /> Couniv wic- _I'vxv <br /> 10. 'Icaj Data <br /> Acreage of Prop" 5 . 5 acres <br /> UTM Rofor*ncft <br /> (Plac* addftnaJ UTM refororeom on a conOrmation sheet.) <br /> 16 6 6 <br /> 00 <br /> zonaEaslilg Northing Zanrl <br /> 2 4 <br /> J— <br /> Voftwl Boundary Description <br /> (Describe" boundaries o!the ptoperty on a com)nuation sheet.) <br /> BourWary Justfffcatlon <br /> (Explein why the boundvAea were sakicted an a oonlinuatkyn sh".) <br /> 11. Form PrepanW By <br /> narnoMle Patricia S. Dickinson, Consultant <br /> organization date __Agri 1 _L9,___j9 <br /> street & mimber . 4 6 0 6 Hunt Rd. telephano ( 919 ) 7 3_2-5 4 3 9 <br /> city or town Hillsborough state :NTC zi:p 2 7 2 7 8 <br /> AddMonall DocumentaMm <br /> Suomrt 'he NxIowmg items-hith the compisted form: <br /> Cantinuatton Shoots <br /> M" <br /> A USGS map (7.5 or 15 minute series) indicating the property's locaticn. <br /> A Sketch map for •1,,istoric dlsit=s and properties having large acreage or -i-ort%5rous msour-.e3. <br /> Photographs <br /> Representative black and white photographs of the property. <br /> AdcRtkma4 items <br /> (Check with the SHPO of FPO for any a0dMortaJ Items) <br /> Pr2pn Owner <br /> (Comploto this atom at the request of SHPG of FPO.) <br /> nam Robert T. Golan and Diana Montgomery <br /> street & number 1830 Hall 1 s Mill Road <br /> city or town E£land state .�-Vc zip code <br /> P"rwark R*duci[Gn Act SWOMeft. T111a Infamatim ia twfw, co3w<,tsd to iipplltni!nns to the N-almAtO RNnM& o" H18torIC Pift"S to n-anili,A- <br /> properjl6s for listing or deltermne 01119)bIlity for 111611rig, to fiv Oropert4es, and to amand 3xo,pq RI-IJO?XlO to Rif8 r+W"Ueq as -0 CA:!W.! <br /> a tnneflt in accordance with the National Hlitoric Praaejv3llon Act, -U arrafid)l (16 470 M ay.). <br /> Eomated I!iurden atewnent. Puoliu ropofimg burlon for cii3 Corm is 9stirmted in avafago 18.1 houfr,par redpontf, ;n,;ftA1n.j ifniq im ;vIOWIM-, <br /> instructions, galharing and maintaining data, and comploono tod vui4fi%ing the folm, C44M.t ragardtxj INA uurdon 63tir.Ekte -)(VY-MVCt <br /> of th.13 form to the Chief, AdndofsuatNti S-mioes Oliviskv,. Nawna; ParIA S*rr!o% P,O, U*'-i 37'27, V%�a_tpinqlon. C '.,00;-71:T nd tkv 01,1:-,C, <br /> Management and Budget. Raparworx Saduv,v;nfi F;fojqoI_A kVwh]nqtw, W ::0503 <br />