ESHPF PROGRAM PROPERTY OWNER CONSENT FOR PARTICIPATION HISTORIC PRESERVATION GRANT APPLICATION

PROPERTY OWNER CONSENT FOR PARTICIPATION IN GRANT APPLICATION

Emergency Supplemental Historic Preservation Fund (ESHPF)
Alabama Severe Storms, Straight-line Winds, and Tornadoes - DR-4684-AL

Affected Jurisdiction: Selma, Alabama
Select District*

Old Town Historic DistrictIce House Historic DistrictRiverview Historic DistrictWater Avenue Historic DistrictSelma University Historic DistrictIndividual Designation
Individual Listed Property
Property Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Legal Description (Parcel ID Number)
I. Property Owner Authorization I, the undersigned, am the legal owner or authorized representative of the property located at

I acknowledge that the above-referenced property is being proposed for inclusion in the City of Selma's application to the National Park Service Emergency Supplemental Historic Preservation Fund (ESHPF) for preservation and recovery assistance in response to damage sustained during the January 12, 2023 tornado disaster, as part of FEMA Disaster DR-4684-AL.

II. Consent and Authorization By signing this agreement, I hereby grant the City of Selma, and its agents, consultants, contractors, and authorized representatives, full permission to:
- Access the property for the purposes of inspection, damage documentation, and historic assessment;
- Include this property in the official project scope for stabilization, repair, or rehabilitation under the federal grant;
- Coordinate all required reviews and documentation with the Alabama State Historic Preservation Office (SHPO), including those required under Section 106 of the National Historic Preservation Act.
III. Standards and Conditions I acknowledge and agree that:
- All work performed using federal funds will be conducted in accordance with the Secretary of the Interior's Standards for the Treatment of Historic Properties and no prior financial assistance was received for said work.
  No work will proceed on the property without my further review and permission following project design and environmental review phases.
- I will cooperate with project staff, preservation professionals, and governmental entities in facilitating grant-eligible preservation activities related to the proposed scope.
IV. Owner/Representative Signature
Printed Name*
Title OwnerAuthorized Representative*
Email*
example@example.com
Phone Number*

Area CodePhone Number
Signature*

Clear
Date*

MonthDayYear
Date
City of Selma Planning & Development Department

Attn: ESHPF Historic Preservation Project

Selma City Hall, 222 Broad Street (2ⁿᵈ floor) Selma, AL 36701
Should be Empty:

PROPERTY OWNER CONSENT FOR PARTICIPATION IN GRANT APPLICATION

City of Selma Planning & Development Department