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DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT, MARYLAND HISTORICAL TRUST (Historic Sites Survey) var.d. MSA SE16-5 Image No: se16-5-0222 Enlarge and print image (50K) |
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DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT, MARYLAND HISTORICAL TRUST (Historic Sites Survey) var.d. MSA SE16-5 Image No: se16-5-0222 Enlarge and print image (50K) |
| NFS Form 10-900 (Rev. 11-90) OMB No. 10024-0018 United States Department of the Interior National Park Service NATIONAL REGISTER OF HISTORIC PLACES REGISTRATION FORM Has form is for use in nominating or requesting determinations for individual properties or districts. See instructions in How to Complete the National Register of Historic Places Registration Form (National Register Bulletin 16 A). Complete each item by marking "x" in the appropriate box or by entering the information requested. If an item does not apply to the property being documented, enter "N/A" for "not applicable." For Junctions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. Place additional entries and narrative items on continuation sheets (NPS Form 10-900a). Use a typewriter, word processor, or computer, to complete all hems. 1. Name of Property______________________________________________ Historic name: Clover Crest__________ Other names/site number: Salmon/Stohlman House______________________________ 2. Location __ ____ _______ Street & Number: 4728 Dorset Avenue________________________________ City or town: Chevy Chase____________[N/A ] Vicinity_________________ State: Maryland_____Code: MD County: Montgomery Zip Code: 20815____r___ 3. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this [ ] nomination [ ] request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion, the properly [] meets [ ] does not meet the National Register criteria. I recommend that this property be considered significant [ ] nationally [ ] statewide [ ] locally. ([ ] See continuation sheet for additional comments.) Signature of certifying official/Title Date State or Federal agency and bureau In my opinion, the property [ ] meets [ ] does not meet the National Register criteria. ([ ] See continuation sheet for additional comments.) Signature of certifying official/Title Date State or Federal agency or bureau 4. National Park Service Certification L, hereby, certify that this property is: Signature of the Keeper Date of Action [ ] entered in the National Register. __________________________________________________ ( ) see continuation sheet [ ] determined eligible for the National Register ( ) see continuation sheet [ ] determined not eligible for the National Register __________________________________________________ [ ] removed from the National Register __________________________________________________ [ ] other, (explain:) ______________________________________________ |