13 CAR pt. 10, Appendix A. Arkansas Historical Marker Program Application

ARKANSAS HISTORICAL MARKER PROGRAM APPLICATION Please read the guidelines before filling out the application. If you have any questions, please contact the Historical Marker Program Coordinator. Submit your completed application to: Arkansas Historical Marker Program Department of Arkansas Heritage 1100 North Street Little Rock, AR 72201 ATTN: Program Coordinato r Sponsor Information Name of organization submitting the application Mailing address (street address or P.O. Box) City State Arkansas Zip+4 Contact name Mailing address (street address or P.O. Box) City State Arkansas Zip+ 4 Daytime phone Email address Fax Statement of Responsibility: The sponsor agrees to donate money to the State of Arkansas for half the cost of the manufacture of a historical marker as described in this application (plus a one-time maintenance fee if the marker is damaged or destroyed) and agrees to install and maintain the marker as required by the State of Arkansas. The sponsor recognizes that the marker is owned by the State of Arkansas and makes no claims to ownership of the marker. Signature of authorized representative Date Name of authorized representative Title Arkansas Historical Marker Application Page 2 of5 General Marker Information Subject of the proposed marker Briefly state why this subject is significant to Arkansas history Will the marker be placed on a site listed in the National Register of Historic Places? Will the marker be placed on a site listed in the Arkansas Register of Historic Places? Will your marker have the same text on both sides or different text on each side? Marker Location Information The marker must be accessible to the public and have safe parking nearby. Address Describe the location, including cross streets Is this site accessible to those with physical limitations? Is there safe automobile parking within I 00 feet of the proposed location? Please attach a map showing the proposed location. The map may be a city or county map, a USGS topographic map, or a sketch map. Be sure to indicate major cross streets and include a north arrow. Please attach a photograph of the proposed location. Arkansas Historical Marker Application Page 3 of5 Marker Installation Permission Is the proposed marker location on public property or private property? Owner name Owner mailing address (street address or P.O. Box) City State Zip+4 Daytime phone If the site is on public property please provide the name and title of the person authorized to grant permission to install the marker. Daytime phone Email address Is a permit necessary to install the marker? Has the necessary permit been obtained? Statement: I recognize that the historical marker is the property of the State of Arkansas and that the historical marker must remain where it was originally installed. I agree to the placement of the historical marker on my property and make no claim to ownership of the marker. Owner or authorized representative signature Date Note: If the marker is to be placed on a state highway, US highway, or other state maintained right-of-way you must contact the Arkansas State Highway and Transportation Department district engineer to obtain a permit before submitting the marker application. Permits may also be necessary to install markers on city or county property or road rights-of-way. Please check with your city or county government to see if you need a permit to install the marker. Arkansas Historical Marker Application Page 4 ofS Marker Delivery Information Provide a business address where the marker may be delivered between 8:00 a.m. and 5:00 p.m. weekdays. Residential addresses are unacceptable. Please note that someone must be on hand to accept delivery and to assist in unloading the marker and post. Business name Street address City State Arkansas Zip +4 Contact at address Contact phone number Marker Payment Information When your marker is approved you will receive notification from the Department of Arkansas Heritage as well as a statement for your half of the current cost of the marker including a $200 one-time maintenance fee if the marker must be repaired or replaced. Payment instructions will accompany the statement. Total amount due must be submitted within 30 days of the notification. If payment is not received within 30 days, your application will be considered void. Pricing is subject to current market rates. Current Pricing for Markers through May 1, 2018: Markers are 42" wide x 30" high with a 7' post and I" lettering. Text is on both sides of the marker and can be the same text on each side or different text on each panel if a longer story is to be told. Marker cost includes prepaid delivery to anywhere in Arkansas. Same text on each side: $] 850.00 Different text on each side: $1950.00 Add one-time maintenance fee: $200.00 The photo is an example of the approved marker design with the Great Seal of the State of Arkansas at the top and the Department of Arkansas Heritage logo and marker sponsor name at the bottom of the text. Additionally, a QR (Quick Response) Code located in the lower corner allows you to scan the barcode with a smart device and immediately receive more pertinent information regarding that specific marker. Arkansas Historical Marker Application Page 5 of5 Marker Text List the facts that you feel are important to include on the marker. Remember - Space is limited. Include only the most important facts. 1 2 3 4 5 6 7 8 9 10 1 1 12 Marker Text Documentation You must include photocopies of sources that verify the facts above. Please see the application guidelines for a description of the necessary documentation. Applications with information that is not properly documented will be returned.