Municipal Heritage Inventory - Nomination Form

Please note, an * indicates a mandatory field.
Please be sure to fill in all mandatory fields.
Telephone numbers are required to be numbers only with no spaces, letters or characters e.g. 92736000.

MHI - Nomination Form
Contact Details
Name: *
Address:
Telephone:
Email Address: *
The Place Being Nominated
Name of Place (if any):
Address / Location: *
Suburb: *
Title Details:
Materials – Walls:
Materials – Roof:
Materials – Other:
Physical Description:
Construction Date:
Modifications made since construction:
Original Owner:
Other Owners:
Original Designer:
Original Builder:
Other Information
How does this place relate to the history of the City of Vincent (in your opinion)? *
What is significant about this place that it should be entered on the Municipal Heritage Inventory (in your opinion)? *
Other Heritage Listings (e.g. National Trust, Heritage Council, other group):
References (e.g. books, historical photographs, certificate of title, maps, sewerage plans, postal directory, correspondence, newspaper articles etc):
Other Comments
Please upload any related documents/photographs (if more than one is necessary you can compress these into a zip file. For help on how to do this please Click Here)