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Get Usda Rural Development Form 1940 1

Form RD-MN 1940-1 4-9-02 USDA RURAL DEVELOPMENT STATE HISTORIC PRESERVATION OFFICE REVIEW Certain actions by USDA Rural Development must be reviewed by the State Historic Preservation Office SHPO to determine if it will affect historic or archaeological properties listed on or eligible for listing the National Register of Historic Places. Applicants should request this review during the pre-application process so that the SHPO response is available to Rural Development for completion of their environmental assessment. To initiate the SHPO process complete this form and send it to Dennis Gimmestad Government Programs and Compliance Officer State Historic Preservation Office Minnesota Historical Society 345 Kellogg Blvd. West St* Paul MN 55102 Phone 651-296-5462 DATE SUBMITTED PROJECT LOCATION County Township or Municipality Name of Project Property Address or Legal Description Attach county map city map plat map aerial photo and/or other maps showing exact location of all project activities. U PROJECT DESCRIPTION Describe the proposed project activities i*e* new construction demolition remodeling installation of sewer/water lines earth moving etc* DEVELOPER Name Address Phone Contact Person PHOTOS Are any building more than 50 years old located on the property YES NO If yes please attach photo of building. For sale of government owned property attach photos of all structures more than 50 years old located on the property. EIS or EAW Has an EIS Environmental Impact Statement or EAW Environmental Assessment Worksheet been completed on this project YES NO If so your project may have already been reviewed however Rural Development still requires that you obtain SHPO comment. ADDRESS TO WHICH SHPO COMMENT SHOULD BE SENT 7. ADDRESS OF RURAL DEVELOPMENT PROCESSING OFFICE TO BE COPIED BY SHPO REMEMBER TO ENCLOSE MAPS AND/OR PHOTOS AS REQUIRED ABOVE. Applicants should request this review during the pre-application process so that the SHPO response is available to Rural Development for completion of their environmental assessment. To initiate the SHPO process complete this form and send it to Dennis Gimmestad Government Programs and Compliance Officer State Historic Preservation Office Minnesota Historical Society 345 Kellogg Blvd. To initiate the SHPO process complete this form and send it to Dennis Gimmestad Government Programs and Compliance Officer State Historic Preservation Office Minnesota Historical Society 345 Kellogg Blvd. West St* Paul MN 55102 Phone 651-296-5462 DATE SUBMITTED PROJECT LOCATION County Township or Municipality Name of Project Property Address or Legal Description Attach county map city map plat map aerial photo and/or other maps showing exact location of all project activities. West St* Paul MN 55102 Phone 651-296-5462 DATE SUBMITTED PROJECT LOCATION County Township or Municipality Name of Project Property Address or Legal Description Attach county map city map plat map aerial photo and/or other maps showing exact location of all project activities. U PROJECT DESCRIPTION Describe the proposed project activities i*e* new construction demolition remodeling installation of sewer/water lines earth moving etc* DEVELOPER Name Address Phone Contact Person PHOTOS Are any building more than 50 years old located on the property YES NO If yes please attach photo of building.

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