Application for Certified Local Government Status

 

Official Name of Government Requesting Certification: _______________________________

 

Name of Chief Elected Official: _______________________________

 

Address: _______________________________

 

 

Name of Contact Person: _______________________________

Phone: _______________________________

 

Name of Historic Preservation Commission: _______________________________

 

Name of Historic Preservation Commission Chairman: _______________________________

 

Address (if different than above): _______________________________

 

Phone: _______________________________

 

Time and Place of Commission Meetings: _______________________________

 

 

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APPLICATION CHECK LIST

 

 

To complete the Application for Certification, please submit the following:

 

___1.   Letter of request for certification from the chief elected official, including assurances that CLG requirements will be met.

 

___2.   A copy of the historic preservation ordinance as adopted by the governing body.

 

___3.   A clearly defined map indicating the location of any historic resources already identified, including the boundaries of any district or districts, and a list of all properties.

 

___4.   A sample notice of public meetings of the commission (if available).

 

___5.   A sample copy of an agenda and minutes of a commission meeting (if available).

 

___6.   A sample notice to an applicant of a decision of the commission.

 

___7.   A list of the members of the historic preservation commission, their terms of office, a resume for each. (Use resume form for this purpose.) If professionals have not been appointed, information must be included to describe efforts to obtain them.

 

___8.   A copy of the rules of procedure of the historic commission.