Historic Monument Plaque Order Form This form can be used to order a Historic Monument Plaque for monuments that meet the eligibility criteria listed on the Plaque Page. Payment can be made by PayPal after input of all information. Historic Monument Plaque Order * indicates required field Name:* Email:* Re-enter Email:* Mailing Address (street):* Mailing Address (city, state, zip):* Preferred contact method:* email telephone Preferred phone number:* Please check the box to signal your agreement with the following statements: The Applicant will place the plaques outside and in an easily accessible public area, clearly visible from the public sidewalk/street right of way* Location of the plaque must be approved by AAPS* The Applicant will maintain the plaque.* Monument Name:* Monument Address (street):* Monument Address (city, state, zip):* Construction and/or Built date(s):* Architect: Builder: Interpretative Text (630 maximum characters including spaces): Is the monument on the National Register of Historic Places, California Historic Landmark, and/or California Register of Historical Resources Yes No Unknown Date listed: California Landmark Number: Is the building part of a City Historic District Yes No Identify Historic District: Mounting Option: Wood screws with rosettes Studs for masonry, stucco, stone Pole mounted (additional cost, AAPS will contact you to discuss) Please remit payment with your application of either the full amount, or a deposit of $300 if applying for a grant. (Grants: AAPS Grants for up to 50% of the cost of the plaque, mounting and installation are available for Alameda Historical Monuments with the submission of a typed letter of application. There is a limit on the number of grants that will be funded each year. Grant applications can be emailed to plaques@alameda-preservation.org with the subject line Historical Monument Grant Application.) Payment:* I agree with the payment policy. Please submit form, and then submit payment using the PayPal button below. Leave this field empty Item choice Plaque payment $425.00 USD Grant request deposit $300.00 USD
