BRI: Plaque Application Form

BRI Plaque Application Form

Please fill out to the best of your ability. Call BRI at 336-0909 or Chris Sturbaum at 336-9171 for assistance with research, advice, or more information.

Name:

Address:

City:

State:

Zip:

Telephone:

Email:

PART I

Check if your structure is:
___ In a Local Historic District

___ In a National Register District
___ In one of Bloomington's old Core Neighborhoods or surveyed districts

PART II

Historic name of structure (name[s] derived from builder, longest occupant, or well-known inhabitant):

Date of construction:

Architectural style:

Use the reverse side of this form to provide any additional reasons you feel your structure is eligible for a plaque.

PART III

Check if this is:
___ the first time you are applying for a plaque; or
___ a replacement plaque; or
___ a restoration/rehab funded by BRI

Cost is $35.00. Please make checks payable to BRI, and send payment and application to the address to the right. This application is subject to review and approval by the Plaque Committee of Bloomington Restorations, Inc.

Bloomington Restorations, Inc.
2920 E. Tenth St.
Bloomington, IN 47408

Return to Bloomington Restorations Store