OKLAHOMA CENTENNIAL FARM AND RANCH APPLICATION OWNERSHIP INFORMATION

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OKLAHOMA CENTENNIAL FARM AND RANCH APPLICATION To qualify as a Centennial Farm or Ranch, your property must meet the following criteria: a. Must have been occupied by a member of your family for at least 100 years. b. Must be a working farm or ranch with a minimum of 40 acres. c. Must have gross yearly sales of at least $1,000. d. Must be either operated by a family member, lived on by a family member, or leased out by a family member. Is this application being prepared as a surprise for the owner (s)? Yes No (If this application is a surprise, please include contact information on the continuation sheet) OWNERSHIP INFORMATION 1. Name(s) of owner(s): If Trust or Business Name, Name of Contact: Mailing Address: City/State/Zip: Phone Number: Alt. Phone Number: Email Address: Farm Address (if different): City/State/Zip: 2. Name of property to appear on your certificate: 3. The property is a: Farm Ranch. For determining which certificate and sign, if ordered, you will receive. There is no farm & ranch option. 4. Name of the person who farms or ranches the property if not yourself: 5. If you listed a person in Item #4, how is that individual related to you? 6. Do you live on the property? Yes No 7. What are the major crops or products of your farm or ranch?

CURRENT GEOGRAPHIC INFORMATION 8. In what county is your property located? 9. What is the legal description of your property (Section, Township, Range)? 10. Provide directions for finding your property beginning in the nearest city/town (list town name). 11. How many acres does your property now include? HISTORICAL INFORMATION 12. In what year did a member of your family originally occupy your property? 13. List all family members, from the original to the present, who have occupied your property: (Name) (Relationship to Present Owner) 14. Provide copies of documents that contain date of original occupation, original claimant s name and legal description of original claim. Attached are: Abstracts Deeds Records of Indian Agencies Homestead Applications Federal Tract Book Information Titles Patents Other

15. Please provide the following historical information about your farm or ranch: a. How many acres were in the original property? b. What crops and/or livestock were produced on the original property? c. How did your original family member acquire the property? d. In which land opening was your property acquired, if applicable? e. Briefly summarize one or two interesting stories about your property. Use the suggested topics list available with this application or on the website at www.okhistory.org/shpo/farmandranch.htm. Use additional pages, if necessary. STATEMENT OF OWNERSHIP I declare that the statements made in this application are accurate and correct to the best of my knowledge. Signature Date Printed Name Relationship to Owner

HISTORIC STRUCTURES AWARD If your farm or ranch includes buildings or structures over 50 years old, you may qualify for a special Centennial Farm and Ranch Historic Structures Award. In order to be eligible for the Historic Structures Award, a farm or ranch must have four (4) standing buildings (house, granary, barn, chicken coop, etc.) or structures (windmill, corral, ditch, etc.) that are more than 50 years of age and have not been significantly altered. An Oklahoma Historical Society, State Historic Preservation Office s Historic Preservation Resource Identification Form for each building or structure must be completed and photographs must be provided as detailed in the instructions accompanying the survey form. These forms and instructions can be obtained online at www.okhistory.org/shpo/farmandranch.htm, by selecting the option below or by telephone at 405/521-6249. Please list buildings and structures on your property (farmhouse, barn, sheds, windmill, etc.) and give the approximate date of construction and current use. (Buildings) (Date of Construction) (Current Use) I wish to apply for the Historic Structures Award. Please send me the forms and instructions. MUSEUM AND ONLINE USE OF YOUR FAMILY S STORIES AND PHOTOGRAPHS: The Oklahoma Historical Society (OHS) maintains a museum exhibit of the Centennial Farm and Ranch recipients to highlight the history and perseverance of the families. Please indicate below whether the Oklahoma Historical Society has your permission to share your family s stories and photographs in its museum exhibit or in any OHS website/publication that may be created. No personal information such as address or phone number will be included in a museum exhibit, online website or publication. Do you give permission for OHS to share included family stories? Yes No Do you give permission for OHS to share included photographs? Yes No Would you like to receive our quarterly newsletter? Yes No Return application and $10.00 application fee (made payable to the Oklahoma Historical Society) to: State Historic Preservation Office, Oklahoma Historical Society, Oklahoma History Center, 800 Nazih Zuhdi Drive, Oklahoma City, OK 73105 To what newspaper should a press release be issued (say none if you do not want one issued)?

CONTINUATION SHEET FOR CENTENNIAL FARM & RANCH APPLICATION

CONTINUATION SHEET FOR CENTENNIAL FARM & RANCH APPLICATION