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12.legal description of the property <br />Your County Assessor can provide you with the if you don’t already have one. <br />Jefferson Place Subdivision as platted, October 12, 1880. <br />Legal Property Description: <br />13.Local, State and National Designations: <br />Don’t know if you are designated? For a list of local designation authorities, <br />go to http:/coloradohistory-oahp.org/publications/pubs/1568.pdf <br />To find out about State and National Register designations, call Chris Geddes 303-866-4683 or Heather Peterson 303-866- <br />http://coloradohistory-oahp.org/programareas/register/regionmap.htmto determine which staff <br />4684. Check the map at <br />member--Chris or Heather--is responsible for the resources in your area. <br />N/A <br />Designation : <br />(choose all that apply) <br />Local Colorado State Registerof Historic Properties National Register of Historic Places <br />What is the area of the designation? <br />Building only Building and the surrounding area Acreage only <br />If locally designated, you must attach verification of the designation to the application. <br />14. <br />If your project involves (1) cash funds from federal or state agencies [such as Rural Development, HUD, Department of <br />Local Affairs], (2) a federal or state agency issuing a permit or a licenseor (3) property owned or managed by a federal or <br />state agency, check “Yes.”If none of these apply, check “No.” <br />If you check “Yes”or are uncertain about which box to check, contact Dan Corson at 303-866-2673 or <br />dan.corson@chs.state.co.us <br />X <br />Yes No <br />15.This signature is required on all applications. <br />This is the legally authorized signature for the applicant organization. <br /> , City Manager <br />___________________________________________ _________________________ <br />Signature of Legally Authorized Representative Date <br />16.You must initialthe following to indicate that you understand and agree with the following conditions associated <br />with State Historical Fund grantsif awarded: <br />___ I understand my organization will enter into a contract with the State Historical Fund (SHF). My organization will become <br />a state contractor and cannot “pass through” fiscal or project responsibility to another organization. <br />___ I understand the proposed cash match must beavailable before my organization signs the SHF contract. <br />___ I understand SHF funds will be paid only for worktaking placewithin the SHF contract period. <br />___ I understand my organization cannot use funds in a manner that may result in an actual or perceived conflict of interest. <br />(See Handbook, p.36) <br />___ I understand property restrictions may be required as a result of an acquisition and development project.For architectural <br />survey projects, I will adhere to the current Colorado Cultural Resource Manual. <br />___ I understand that once under contract, I will work in partnership with the State Historical Fund to meet the Secretary ofthe <br />Interior’s Standards. I will comply with review expectations and refrain from carrying out work until I have the approval of SHF <br />historic preservation specialiststo proceed. <br />___ I understand that my performance as a state contractor will be evaluated and madeavailable to the public. <br />___ I understand that indirect costs need to be justified at the time of request for reimbursement. I am encouraged to use the <br />SHF Indirect Cost Worksheetfor planning purposes. <br />46 <br /> <br />