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Historic Marker Application

2021-2022 QQA Cheryl Griffith Nichols Historic Building Marker Program Application

Please print this page, fill out the application below, and return to the QQA using the information below.  

Owner’s Name:

 

Owner’s Email:

 

Street Address of Historic Property:

Owner’s Daytime Phone Number:

Are you a QQA member? Yes    No

The historic building is (circle one below):

  • Listed Individually on the National Register of Historic Places
  • A Contributing structure in the following National Register Historic District
  • Eligible for individual listing on the National Register of Historic Places, as determined by the Arkansas Historic Preservation Program
  • Other

If the historic property is contributing to a National Register Historic District, in which district is the property located?

Is there a QQA House Marker at this Address? Yes     No

If you choose yes in the above question, please tell us the historic name and date listed on the current marker:

Year purchased by current owner:

Year Built:

Please include the following documents with this application by attached additional forms:

  • A history of the home's ownership history, beginning with the original owner. 
  • At least one current photo of the historic property that clearly shows the main elevation (front).

Process Information

QQA staff and/or the QQA Marker Committee will determine whether the construction date and ownership history provided by the applicant are consistent with sources including the National Register of Historic places nomination for the building or district, and the Butler Center for Arkansas Studies QQA Records. Any discrepancies will be discussed with the applicant before a decision on the application is made. All application materials become the property of the QQA. Please indicate that you have read and accept this information.

Signature:_________________________________________________________

Date:_____________________________________________________________

Please mail this application and additional required documents to: QQA PO Box 165023, Little Rock, AR 72216 OR email this form and additional required documents as a .pdf to patricia.blick@quapaw.com with “Historic Marker Application” in the subject line