Old
House Questionnaire
Your Name: :__________________________________________
Your mailing address (if different from the house
address)
_____________________________________________________
Your telephone number
(_____)______-________
Map and
Year that current owner acquired the house:
_______________
Date the house was originally built:
______________
If you know the date, give it; If you are guessing, write c1914 for example.
Who was the first owner?
_______________________________________________
Names of other owners with their dates of
acquisition:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Please include any interesting historical data, lore
or family legends about the house. Use the other side and feel free to include
extra sheets as needed.
If you have a spare copy of a picture of the house
(either new or old), please include it and pencil the date of the picture and
the
Are you interested in helping with the project? Yes __ No __