.:
PLEASE'PRINTQRTYPEANSWERS
th~'followinginfonnation
;is.
necl:;$llary
.i,n
determining.~ligibili~andin,prepilrihgentriest;orthe,randlyLand
'Heritage-legls'!:r9:">;
If
additional
'space
isn~edeq.submitinateri.alon
a
sepa,ratesheet.givingtheSectionnumhe,rand
the
it~
number.
InSect,ionH.
please
addthl.oaPl?ropriateletter(AorB).'.
,4_-'••".-,"_.
If
youhaveoldphotographsoftheland,
buildings
orsettlers
'which_we
couldcopy,
pleasewrite
'yourname,andaddress
01;1
theback,id~1:ifythepersonsor
subject
andsubl)litthem
with
yourapplication.SOO1e-ofthesephotographs
willbe
printed
in
the
Registry;
others
maybeusedinaslideshowontheProgram.
'All
willbereturi)ed.'
_Kf
shallassumethe
right
.!2
publish
.i!!!Y
·.photographs
subnitted
to,~Tennessee
Depart-
.ment
ofAgriculture.
Donot
send
any
original.docUmentst,6-
t~e
Dep~rt-
mentt:hat
need
tobe
t"IE'turned.·However"
these
wil--l
be
useful
in
deter-mining
eHgib"ility
by
·the
countyhiEft:orianor
designee
oftheDepartment'.
Informationwith
.2!!
asteli'is'k~-must·be-cOO1ple.ted.'
SECl1QN
J:
1975
OwNERSHIP
-Foreach1975owner,
give
thefoIlowinginformation:
1.
FullNarne
-llJm;a..--lili::l,I.J,!MIliIi:R:R--&&~E:l'ja~:NJ!E~S"",'l'~:OUlA..-\jll""Z,.:;;S>--::--,lII_lIIu.J:.,;:S;..;;Si---..lJ~AU'llIIlMA"__'D....&i",,1T'-.II.
S,__~~__
(Pleasewrite
Mr.
and/or
Mrs.,
or
Miss)
County
,mount-
Phone
No:from
8
a.m.
105p.m.-61.5
983-1569
(Inwhichyoureside)(Area'Code)(Number)
,}..FullName_JWu:uS:LJKr.tI.LI'_',.L,DlJ:lRltE!aDLJD.l__.J.,DwrA..!VTLUD.Ji~:lJO..l.WI1--:-
r
(PleasewriteMr.and/OfMrs.,orMiss)
Address
309
LIVEAOK
DRIVES.
w.
KNOXVILLE
TEIlN
3'78920
(Route,P.O.80)<,Of'Sheet)
(City)(Zip
Code)
.
.
,~.
CountyKHOXPhOneNo.from8.a.m.toS-p.m.
6155'7'7-7834
-(Iilwhich-y~ureSide)
(Area'Code)
(Number)