Application for Heritage Designation

Required fields are marked with asterisks (*)

Application for Cultural Heritage Value or Interest Property Designation

Section 29 of the Ontario Heritage Act ("Act") enables municipalities to pass By-Laws for the protection (designation) of individual real properties that have cultural heritage value or interest to the municipality.

To make a request for a property to be designated under section 29 of the Act, please complete the following form.

If you have any questions about this form, or would like to request the form in an alternate format, please contact the Office of the Clerk at 519-688-3009.

Name of Applicant(s)

Address

Town

Province

Postal Code

Phone Number

Email Address

Civic Address of Subject Property

Are you the Owner of the Subject Property?

Yes

Current and/or Historic Building/Property Name (if known)

Date of Construction (if known)

Please select the following criteria which describes the Subject Property:

The property has design or physical value: is a rare, unique, representative or early example of a style, type, expression, material or construction method; displays a high degree of craftsmanship or artistic merit; demonstrates a high degree of technical or scientific achievement.

The property has historical or associative value: has direct associations with a theme, event, belief, person, activity, organization or institution that is significant to the community; yields or has potential to yield, information that contributes to an understanding of a community or culture; demonstrates or reflects the work or ideas of an architect, artist, builder, designer or theorist who is significant to a community.

The property has contextual value: is important in defining, maintaining or supporting the character of an area; is physically, functionally, visually or historically linked to its surroundings; is a landmark.

Please provide any additional information regarding the Subject Property for consideration during the evaluation process:

Please attach historic and/or current photo(s) of the exterior of the building.

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

Have you been in contact with a Town of Tillsonburg staff member regarding the Cultural Heritage Value or Interest Designation process?

Yes

Name of staff member:

I hereby declare that all of the information provided in this application form is true and correct to the best of my knowledge and that all information submitted in support of this application may be made available for public review.

Yes