Do you know of a special irreplaceable historic building or site that is in danger of being lost? If so, this is
your opportunity to help save it! The Georgia Trust’s Places in Peril program identifies historic sites
facing real threats like demolition, neglect, lack of maintenance and inappropriate development. Bring
attention to Georgia’s threatened resources by making a nomination to the 2013 Places in Peril list.
To make a nomination, complete this form and return it to The Georgia Trust marked “Places in Peril” at
1516 Peachtree Street, NW, Atlanta, GA 30309 or email to kryan@georgiatrust.org. Nominations can
be e-mailed or mailed, but must be postmarked or received by Monday, June 4, 2012. Be sure to
submit 5 to 10 digital images (minimum size 4" x 6" jpg format at 300 dpi) on a CD. All materials
submitted with the application are non-returnable and become property of The Georgia Trust. For
further information, contact Kate Ryan at 404-885-7817 or kryan@georgiatrust.org.
Name of Property
Property Address
City/County
Construction Date
Ownership
Historic
Designation
Public
National
Historic
Landmark
Private
National
Georgia
Register of Register of
Historic
Historic
Places
Places
Locally
Designated
Unknown
Name
Address
Phone
Email
Association with
Property
Name
Address
Phone
Email
Are they aware of
nomination?
Y
N
If so, do they
support it?
Y
N
None
Name
Address
Phone
Email
Association with
Property
On no more than two additional pages, please briefly answer the following questions (please type). All
questions must be answered for the nomination to be considered.
1) Why is the property significant? Is it architecturally and/or historically significant? Does it
contribute to a historic district? What makes it unique or different?
2) What is the history of the property? Please provide a brief historical summary.
3) Describe the nature of the threat to the property (demolition, neglect, lack of maintenance,
inappropriate development, insensitive public policy, etc.). How imminent is the threat?
4) Has any recent or past preservation activity occurred on behalf of the property? Please identify
any entities, organizations and/or agencies that have a goal to save the property. Are they
willing to work towards the implementation of a preservation plan for the property?
5)
Is there any potential opposition to including this site on the list? If yes or maybe, provide the
names, titles and contact information of those opposing the nomination. Please indicate
reasons of each person’s opposition, if known.
6) What would you hope to accomplish if your project is placed on the Places in Peril list?
Completed nomination form
5 to 10 digital images (4” x 6” jpg format at 300 dpi or larger) on CD
*images may be emailed, please do not send images on a DVD
Additional support material: historic designation information, etc. (as appropriate)
All materials submitted with the application are non-returnable and become property of The Georgia Trust.
RELEASE ATUHORIZATION: This form must be signed in order for the nomination to be considered. The undersigned
hereby gives The Georgia Trust a non-exclusive license to use, and allow others to use, in whole or part, all digital
images, videos and other materials submitted to The Georgia Trust in connection with the Places in Peril nomination
for publicity, audiovisual presentation, and/or promotion. The Georgia Trust is hereby given permission to make any
editorial changes and/or editions to the materials referred to herein as it may deem necessary from third parties,
including without limitation, models, creators, photographers, writers and producers, and that the undersigned will
hold harmless and indemnify The Georgia Trust from and against any claim brought against The Georgia Trust from
third parties that may arise out of the violation of this paragraph.
Release authorized by (signature):
Type name and title here: Click here to enter text.
Enter Date: Click here to enter a date.
For more information on the program or individual sites, contact Kate Ryan at 404-885-7817 or kryan@georgiatrust.org.
1516 Peachtree St. NW – Atlanta – Georgia – 30309-2908 – www.georgiatrust.org