Date (required)

    Address of Nominated Property (required)

    Historic Name Nominated Property (if applicable)

    Current Owner Information

    Name (required)

    Address (required)

    Telephone Number (required)

    Email (required)

    Nominated by Information

    Name (required)

    Address (required)

    Telephone Number (required)

    Email (required)

    Does the Owner Agree to be Nominated? (required)

    YesNo

    Type of Property: (required)

    Private HomePublic PropertyCommercial PropertyOther

    Property Information

    (please provide all that you can)

    Year Built

    Name of Original Owner

    Timeline and Names of Previous Owners:

    Timeline of Significant, Architectural Changes to the Exterior and Interior:

    Historical, Cultural, or Social Significance to Pinehurst:

    Other Pertinent or Interesting Information About the Property, its Owners, or Occupants:

    File/Document Upload

    (if you have more than 20 images/documents to submit or you would prefer to submit them via hard copy you may do so by mailing them to: Historic Plaque Committee PO Box 398 Pinehurst, NC 28370)