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The Heritage Society of Pacific Grove
e * Ca 93950 *
- www.pacificg
Green Plaque Application Form
Date of request:__
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Address of the property /6 f f1; c,Y.c.. /+u-e -
Name of owner(s) /vttJJC/
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Owner's phone number__~~-2~'~
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Is this for a replacement plaque??~ (No)
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If yes - what is the name and date on the plaque? -if@
Do you have any information about the history of the
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Signature of owner (required) 77w
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Owner's phone number__~~-2~'~
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___________
Is this for a replacement plaque??~ (No)
l.iz~ie ~. Uc::.\:::.~.e. l'1D6
If yes - what is the name and date on the plaque? -if@
Do you have any information about the history of the
property? . e-
Signature of owner (required) 77w
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