Dover Historic House Marker Program

Application Form

I/We ________________________________________________________ hereby apply for a historic house marker for our property located at  ________________________________________________________________________________________.

Applicant's Address (if different from Subject Property):  _________________________________________________

Telephone Number:  ________________________  E-mail:  ___________________________

Please provide written information about the property to support its eligibility for a marker (below), and attach to this application any documentation you may have in the form of deeds, surveys, etc.:

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

Please include a $150 contribution payable to the Town of Dover Historical Society. This contribution is non-refundable.  However, if the property is not eligible, your contribution will be returned.

I/We have read and understand the program guidelines accompanying this application.

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Signature                                                        Signature

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Date

Mail to: Dover Historical Society
Post Office Box 534
Dover, MA 02030-0204