Municipal Heritage Inventory - 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

References (e.g. books, historical photographs, certificate of title, maps, sewerage plans, postal directory, correspondence, newspaper articles etc)

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)

Other Comments

Please upload any related documents/photographs (if more than one is necessary you can compress these into a zip file.

Maximum size of ALL attachments is 976.56 MB

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