OXFORDSHIRE BLUE PLAQUES BOARD APPLICATION FORM to be completed by those wishing to propose a person or place of historic interest to be commemorated by the erection of a plaque. Before completing the form, please read the criteria on the reverse side (or on the website). Please complete fully and clearly in ink or typescript. ---------------------------------------------------------------------------------------------------------------------------- Details of the person or place proposed to be commemorated by a plaque. 1. Name of person or place in full............................................................................ 2. Date of death of the person, or of the event to be commemorated.......................... 3. How does the person/place fulfil the criteria listed overleaf?................................... ........................................................................................................................... 4. What books, websites or other sources give biographical or other supporting information about the person/event? ........................................................................................................................... ........................................................................................................................... 5. Proposed site of plaque (please see guidance overleaf)........................................ 6. Will the plaque be clearly visible to passers-by?.......................................... 7. What is the relevance of this site to the person/event being commemorated?...... ...................................................................................................................................................... 8. Has the owner/occupier of the building agreed to a plaque?..................................... 9. Is the building listed?..............If yes, what were the comments of the local Conservation Officer? ........................................................................................................................... ........................................................................................................................... 10. How might the plaque be paid for? Please give the names and addresses of potential sponsors, if possible.
........................................................................................................................... 11. Any other comments you wish to make which will assist the Board in coming to a decision
........................................................................................................................... 12. A member of the Board may wish to arrange a site visit. What is the best time of day to contact you?..............................................................................................................
Details of the person or organisation submitting this application. 13. Name..............................................................................Initials..................Title................. 14. Postal Address.................................................................................Postcode...................... ……………………………………………………………………………………………………….. Telephone Day....................................................Evening................................................ E-mail...................................................................Fax................. Please submit this application, with any supporting material, and a photograph of the building showing the proposed site of the plaque, to the Secretary, after completing the following: Signature of proposer....................................................................date.......................... I agree to the plaque being fixed to my property. Signature of owner........................................................................date..........................
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