When your form has been processed, we will provide you with the P.A.S.S. number.

Your Name:________________________________________                  P.A.S.S. #________________

Phone Number:_____________________________________                   Date:___________________

Address: _________________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Site Name: ________________________________________________________________________

Is the site Historic, Prehistoric, or Both? _________________________________________________ _______________________________________________________________________

What kinds of artifacts and/or features are present on the site? ________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

Based on the artifacts and/or features, what time period(s) does the site date to? ____________________ _______________________________________________________________________

Approximately how large is the site (in acres or square feet/meters)? ____________________________ ________________________________________________________________________

County ____________________________________________________________________________

Township ___________________________________________________________________________

Property Owner ______________________________________________________________________

Owner's Address _____________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________

Remember? Ask the landowner's permission before you collect artifacts on private property. It is a violation of state law to collect artifacts from state lands and a violation of federal law to collect artifacts from federal lands! (over)
 

Site Location Map: Please use a USGS 7.5 minute quadrangle map if possible. You can photocopy the appropriate portion of the map, we do not need the entire original quadrangle. Please remember to give us the name of the map and to identify the site location clearly! Attach the map in the space provided below, or enclose it with this form. Remember, an accurate location is the single most important piece of information you can give us for any archaeological site!
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Artifact Illustrations: Please attach photographs or drawings of representative artifacts from the site, remember to provide a scale. What raw materials are the artifacts made of?
 
 
   
 
 
 
 
 
 
 
 
 
 
 
 

Additional Remarks: (Please tell us of any possible threats to this site from human or natural causes)