Historic Building Recognition Form

Plaque Application Form

There is a flat fee of $60 for the historic research report produced by the Trumbull County Historical Society. This application will be forwarded to the Historic Sites Committee of TCHS for review and action. Please fill out the form to the best of your ability, some fields you may be unable to complete.

Name

Phone Number

Address

City

State

Zip Code

Do You Own This Property?

Yes No

If no, provide contact info for the owner.

Site Type

Home Other

Location

Section Number

Lot Number

Lot Size or Acreage

Out Lot

Date of Construction

Architectural Style or Design

Original Owner / Builder

Original Use / Present Use

Date of Alteration

Significant Person / Events Associated with Property

Is the Building on the Original Site?

Yes No Unsure

Description & Appearance

Payment Agreement

By submitting this application, i certify that the trumbull county historical society may bill me the $60 fee for the historical research report.