Local Government Annual Reporting
Supplemental Forms



New Commissioner Resume
If you are a Certified Local Government and have members serving on your local historic commission who have not served before, you must complete one form for each new member.  Non-CLG commissions may elect to complete this form as well.

Resource ADDED
Certified Local Governments are required to maintain an inventory of all historic buildings, structures, and sites within their jurisdiction, whether or not those properties are locally designated and whether or not they have been placed on the National Register of Historic Places.  If your Certified Local Government has ADDED resources to this inventory during the reporting period – whether or not they have been placed on the National Register or locally designated – you must complete one of these forms for each resource.  Non-CLG commissions are encouraged, but not required, to complete this form as well.

Resource LOST
Certified Local Governments are required to maintain an inventory of all historic buildings, structures, and sites within their jurisdiction, whether or not they are locally designated and whether or not they have been placed on the National Register of Historic Places.  If your Certified Local Government has had resources LOST from this inventory during the reporting period – either through demolition or relocation, and regardless of whether or not any had been placed on the National Register or locally designated – you must complete one of these form for each resource.  Non-CLG commissions are encouraged, but not required, to complete this form as well.

Commission staff can download, fill in, sign, and email these forms using the latest version of the free Adobe Reader:

1.    Open the PDF and choose “SIGN” from “TOOLS/SIGN/COMMENT” at upper right.
2.    Fill in your information.  When typing in comment boxes, do not write more than the box will hold without scrolling (about
       240 words or less).

3.    Click “PLACE SIGNATURE”
4.    In the dialog box that pops up:
a.    Choose “TYPE MY SIGNATURE” or “DRAW MY SIGNATURE” or “USE AN IMAGE” (e.g., if you have a scan of your signature)
b.    Click “ACCEPT”
c.    Place your signature on the line provided and resize if necessary
5.    Click “DONE SIGNING” and then “CONFIRM”
6.    Save the file
7.    Click “UPLOAD”
8.    Complete the information on the Adobe page
9.    Email to rob.crawford@ncdcr.gov
10.    Check the box to agree to terms and click “DELIVER”

If you have any questions or problems completing the form or signing electronically, please call Rob Crawford, Preservation Commissions Coordinator, at (919) 807-6580.


N.C. State Historic Preservation Office Home Page
Office of Archives and History Home Page
N.C. Department of Cultural Resources

10/15/2012