LANDMARKS
of New York State
Structural Landmark Survey Form
Enter the requested information, then click on "Submit the Form" to complete the process.
Note: It is not necessary to provide all the information requested, partially completed forms may be submitted. If necessary, more information may be submitted on a new form at a later date. Digital photos/scans may be submitted in jpg format by email to this address: info@nysLandmarks.com.
Send an email to snyaia150@verizon.net with any questions.
Click Here to open a new window and get info from the National Register
Name of Landmark
  • Historic Name
  • Current Name
    • Location
  • County
  • Township
  • Address
  • Directions
    • Type of Landmark

    Other:
    Landmark Designation
    National Register
    Natl Register Desired
    Natl Register Historic District
    Other:     		Local Landmark
    Local Historic District
    State Historic Marker
    Historic Marker Desired
    Landmark History
  • Date Built
  • Builder
  • Architect/Designer
  • Original Owner
  • Original Use
  • Past Uses
  • Other Information
    • Description of Landmark
  • Architectural Style(s)
  • Number of Stories
    		• Outbuildings
  • Exterior Materials
    • Foundation Walls
    Roofing Other
  • Noteworthy Interior
    • Additions
  • Type
    		• Date
  • Designer/Builder
  • Type
    		• Date
  • Designer/Builder
    • Current Owner
  • Name
  • Ownership

    • Other:
  • Owner Address
  • email
  • Phone
    • Current Use
  • Occupancy
    • Current Condition
    Excellent
    Good
    Needs Repair
    		 Deteriorated
    Threatened
    Funding is Needed to Restore/Repair
    List Threats to Structure:
    Public Access (indicate days & times, cost, phone, email, etc):
    Why is this Landmark Important
    Surveyor Information
  • Name
  • Date Surveyed
  • email
  • Phone
  • Organization
    • Persons Interviewed
  • Name
  • Date of Interview
  • Address
  • email
  • Phone
  • Title (County Historian, Town Historian, etc.)
    • Name
  • Date of Interview
  • Address
  • email
  • Phone
  • Title (County Historian, Town Historian, etc.)
    • Location of Information
    Local Library
    County Library
    National Register
    		 Government Office
    Historical Society
    Private Collection
    List Any Other Sources of Information
    Describe Historic Photos/Documents that are Available
    Website Address
    Additional Comments

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