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DEPARTMENT OF PARKS AND RECREATION GUAM HISTORIC RESOURCES DIVISION (GHRD) (STATE HISTORIC PRESERVATION OFFICE) GUAM HISTORIC PROPERTIES INVENTORY (GHPI) DATA FORM A. IDENTIFICATION: Items 1, 2, 3a, 3b. 1. Data Form Date: ____________________________________ 2. Guam Historic Properties Inventory Number: This number is assigned by GHRD Survey and Inventory staff 66 - ________ - _______________ (Quad number) (Greater than 1300) 3a. Name of Property:______________________________________________________________ 3b. Other Property Name: __________________________________________________________ B. LOCATION: Items 4, 5, 6, 7, 8; Use USGS Topographic map (1:24:000 series) to complete 4, 5, 6. 4a. Place an X below in the appropriate USGS Topographic Map on which property is located. ____ Hagåtña (1) ____ Agat (2) ____ Apra Harbor (3) ____ Dededo (4) ____ Inarajan (5) ____ Merizo (6) ____ Pati Point (7) ____ Ritidian (8) ____ Talofofo (9) 4b. ATTACH MAP: Indicate/locate on USGS Topographic Map where property is located. 5. Local and/or traditional place name of property or area: ______________________________ 6. Municipality. Place and X below on which the Property is located in the Municipality of: ____ Agana Heights; ____ Agat; ____ Asan-Maina; ____ Barrigada; ____ Chalan Pago – Ordot; _____ Dededo; ____ Hagåtña; ____ Inarajan; ____ Mangilao; ____ Merizo; ____Mongmong-Toto-Maite; ____ Piti; ____ Santa Rita; ____ Talofofo; ____ Tamuning; ____ Umatac; ____ Sinajana; ____ Yigo; ____ Yona; ___ Other, specify:____________ 7. Lot Number(s): _______________________________________________________ 8. Size of Property. Indicate total acres and hectares on which historic property is situated on: Acres: ______________ Hectares: ________________ C. PROPERTY OWNER(S) 9. PLACE an X if Property is: ___Private Property; ___Govt. of Guam; ___Federal Property 10a. Indicate Property Owner Name(s)_________________________________________________ 10b. Contact Numbers, Include Fax No.:________________________________________________ 10c. Mailing Address: ______________________________________________________________ 11. Name of Leaseholder, if applicable: _______________________________________________ Page 1 of 4 Revised Form: Feb 2011 D. U.T.M COORDINATES, APPROXIMATE CENTER POINT: Zone 55 12. EASTING / NORTHING. Locate center point for property if one acre or less: Easting ______________________ Northing _______________________ 13. Locate at least three points if property is greater than one acre: 1. E ______________________ N ____________________________ 2. E ______________________ N ____________________________ 3. E ______________________ N ____________________________ 4. E ______________________ N ____________________________ E. CONDITION OF PROPERTY / CURRENT USE 14. PLACE an X if condition of property is: _____ Excellent / Undisturbed; _____ Good; _____ Poor / Deteriorated; _____ Destroyed 15. Briefly describe condition to properly evaluate future preservation efforts: _________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 16. Current Use of Property: ____ Government Office; ____ Hospital / Clinic; ____ School; ____Communications Facility; ____ Habitation; ____ Toolmaking; ____ Social/ Meeting Hall; ____Warehouse; ____Storage; ____ Other-specify____________________________ F. HISTORIC CONTEXT 17. The Historic Context of this Property is best classified as (check one or more): ____ 1687 B.C. Early Latte Period ____ 6 A.D. – 800 A.D. Mid-Pre Latte Period ____ 800 – 1300 A.D. Latte Period ____ 1300 A.D. Mid-Latte Period ____ 1500 – 1700 Late Latte / Early Historic Period ____ 1668 – 1699 Spanish Missionization Period / Chamorro Spanish Wars ____ 1700 – 1898 Spanish Colonial Period ____ 1898 – 1941 First American Colonial Period ____ 1941 – 1944 World War II / Japanese Military Occupation ____ 1944 – 1950 Post World War II /Second American Colonial Period ____ 1950 – 1969 Political Economic Development Period ____ 1970 – Present; Quasi Self-Governing Period G. CULTURAL RESOURCE CLASSIFICATION The term “cultural resources” is broadly defined to include cultural uses of the natural environment, religious and sacred sites, places of traditional cultural importance, historic and archaeological resources, historic objects and documents, and that has some cultural value to a group of people. 18. The Use of this Property can be described best as a place that contains or is valued as a: ___ Natural Resources; ____ Historical Resources; ___Archaeological Resources ___ Religious Site; ____ Sacred Site; ___Spiritual Place of Traditional Cultural Importance ___ Valued by the Community ____ Other:_____________________________________ Page 2 of 4 Revised Form: Feb 2011 H. PROPERTY CLASSIFICATION 19. This property or site can be best classified as (check one box). ____ Site A site can be the location of a significant event, a prehistoric occupation or activity, or a building or structure, whether standing, ruined, or vanished, where the location itself possesses historic, cultural, or archaeological value regardless of the value of any existing structure. ____District A district possesses a significant concentration, linkage, or continuity of sites, buildings, structures, or objects united historically or aesthetically by plan or physical development. ____ Building A building such as a house, church, hotel created principally to shelter any form of human activity. A “building” may also be used to refer to a historically and functionally related unit, such as a courthouse or jail. ____ Structure The term “structure” is used to distinguish from buildings – its function was principally to shelter any form of human activity. Structures can be pillboxes, bookshelves, shrines or monuments. ____ Object The term “object” is used to distinguish from buildings and structures. Objects are primarily artistic in nature or are relatively small in scale and simply created, although it may be by nature or design, movable, an object is associated with a specific setting or environment. I. DOCUMENTS REQUIRED 20. ATTACH / INCLUDE ALL ITEMS BELOW WITH THIS DATA FORM: _X_USGS Topography Map (Section. B.4b. above) Use 1:24,000 series. Photocopy the vicinity of where the property is located on an 8.5 x 11 sheet of paper. Clearly identify the location of this property on this map. _X_ Drawing or Sketch Provice a measured drawing or sketch of this property, preferably on an 8.5 x 11 sheet of paper. _X_ Photographs Digital photos in JPEG, 600dpi. Clearly identify each photo immediately below it. Number each photo page. _X_ Guam and or National Register Registration Forms if Property is Potentially Eligible Refer to National Register documentation requirements. _X__ Digital / electronic copy of documentation ___ Other Documents may include newspaper clippings, articles, sections from a book or magazine. Maps, survey report descriptions, letters, etc. J. DESCRIPTION, STATEMENT OF SIGNIFICANCE, DISPOSITION RECOMMENDATION 21. Provide a description of the property. State: if the property is potentially eligible for listing on the Guam Register and/or National Register; if the property is currently listed; what appropriate action to take if there is a potential danger that the property be vandalized, looted, damaged, destroyed, etc. _____________________________________________________________________________________ _____________________________________________________________________________________ Page 3 of 4 Revised Form: Feb 2011 _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ K. FORM PREPARED BY Name and Title of Individual Completing this Data Form: __________________________________________________________________________________ Company Representing: _______________________________________________________________ Contact Numbers:____________________________________________________________________ Company Address: ___________________________________________________________________ Email Address: ________________________________________________ L. FOR GHRD OFFICE USE Date reviewed: ____________________ Reviewed by: Name and Title of GHRD Staff: ______________________________________________ Date Entered in Inventory ________________________________ Documentation adequate? _______________________________ General Comments: ____________________________________________________________________ STAFF SIGNATURE: ________________________________________ Page 4 of 4 Revised Form: Feb 2011