New Mexico Administrative Code
Title 4 - CULTURAL RESOURCES
Chapter 10 - CULTURAL PROPERTIES AND HISTORIC PRESERVATION
Part 2 - HISTORIC PRESERVATION LOAN FUND
Section 4.10.2.24 - ATTACHMENT C: PRELIMINARY LOAN APPLICATION
Current through Register Vol. 35, No. 18, September 24, 2024
A. PROPERTY INFORMATION
property name:_______________
property address:____________
LOCATION
county:___________________________________ Town/City:_____________________________
historic district:____________________________
rural:____________________________________
APPLICANT
Name:_________________________________
lessee: _____ building/site owner:______________________
address:______________________________________
phone:________________________________________
social security #:________________
CO-APPLICANT
name:_______________________________ lessee:_____ building/site owner:__________
address:_____________________________
phone:_______________________________
OWNERSHIP
public___ private___ non-profit_____
name of owner (if different from above):__________________________
mailing address:_____________________________
phone:_______________________________________
taxpayer ID number:__________________________
owned/leased for _____years
Does the lease state anything about improvements? (if yes, describe)
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
PROTECTION
Is the property under legal protection such as easements or a local historic district ordinance?
Yes_____ No_____
PHOTOGRAPHS OF EACH SIDE OF THE BUILDING
Provide photographs to show all sides of the building(s) adequately. Closeup photographs showing details of the building are also recommended. Photographs must be glossy black and white, no smaller than 5 X 7 inches.
REGISTRATION Yes No
the national register of historic places? ____ ____
a historic district listed in the national
register of historic places? ____ ____
determined by the keeper of the register
to be eligible for listing in the
national register of historic places? ____ ____
If you answered "No" to 1, 2, and 3 above, please answer the following questions:
Is the property individually listed in the
state register of cultural properties? ____ ____
Is the property listed as contributing
to a historic district listed in the
state register of cultural properties? ____ ____
If you answered "No" to 1, 2, and 3 above, complete ONLY the owner's signature section below. Do not complete the remainder of this application. The historic preservation division will inform you if your property is eligible for the loan program. Please submit the completed portion of this form to the historic preservation division.
B. DESCRIPTION OF REHABILITATION/PRESERVATION WORK: In the blocks provided, provide a detailed description of the project. The block titled "description of work and impact on feature" should be used to describe in detail the work on a specific feature. Describe each feature, including a description of its present condition followed by a description of the proposed work and its impact on the feature. Attach labeled and numbered photographs (glossy black and white, no smaller than 5" X 7") of each feature. Use as many blocks as necessary to describe the entire project. Examples of features are stairways, windows, doors, roofing, chimneys, floors, exterior and interior finishes, major spaces, etc. Attach copies of additional blocks if necessary.
________________________________
architectural feature #_____; description of feature and its present condition
photo no. _____ drawing no. _____
________________________________
description of work and impact on feature:
architectural feature #_____; description of feature and its present condition
photo no. _____ drawing no. _____
________________________________
description of work and impact on feature:
architectural feature #_____; description of feature and its present condition
photo no. _____ drawing no. _____
________________________________
description of work and impact on feature:
COST ESTIMATE OF PROPOSED WORK:
To the best of your knowledge, provide an estimate of the proposed work. Itemize separate costs as nearly as possible according to the features described in the description of rehabilitation/preservation work section above.
Itemized:
total estimated project cost:_______________
ESTIMATED PROJECT STARTING DATE:____________
ESTIMATED COMPLETION DATE:__________________
OWNER'S SIGNATURE
I hereby apply for participation in the state historic preservation loan program and I attest the information I have provided is, to the best of my knowledge, correct.
____________________ date:__________
owner's signature
C. CERTIFICATION (for state use only)
The historic preservation division has reviewed this preliminary loan application and
_____approves the preliminary loan application as submitted.
_____approves the preliminary loan application with the
provisions stated below:
________________________________
________________________________
________________________________
________________________________.
_____rejects the preliminary loan application because the proposed work does not conform to the standards set forth in regulations pursuant to this program.
_____tables the preliminary loan application and requests the following additional information before the application will be reviewed:
________________________________
________________________________
________________________________
________________________________.
_______________________ date:__________
division staff reviewer
_______________________ date:__________
state historic preservation officer
