Property Plaque Program Application Form

Appendix A

PROPERTY INFORMATION  (for plaque location)

PLAQUE INFORMATION (Please provide only if known)

If you have additional information regarding the property such as current or historic photos, newspaper articles, maps, property deeds/abstracts, assessment records, census information or any other interesting information, Heritage Kincardine would be very interested in receiving a copy with your information.

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I, the undersigned, hereby authorize Heritage Kincardine to retain all records submitted with this application.  I agree to mount the plaque on the building and understand that the plaque is a fixture for the community and should remain if the property is sold.

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Personal information collected on this form is collected under the Authority of the Municipal Act, 2001, S.O. 2001 for the purpose of creating a record to determine eligibility for a heritage plaque.  Questions about the collection of this information shoudl be directed to the Clerk of the Municipality of Kincardine at 1475 Concession 5, RR#5, Kincardine, ON N2Z 2X6 or by phone at (519) 396-3468.



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