Free 28547.pdf - Indiana

HOOSIER HOMESTEAD AWARD APPLICATION
State Form 28547 (R2 / 11-03)

v RECYCLED PAPER
PLEASE PRINT OR TYPE
Name of present owner(s): Address: City: Address of Farm: City: Township: Date farm was originally acquired by a family member: Number of acres of original acquisition still retained: State: County:

Office of the Commissioner of Agriculture ISTA Center, Suite 416 150 West Market Street Indianapolis, Indiana 46204-2810 Phone: (317) 232-8770 Fax: (317) 232-1362

**Select the Award your Farm is eligible for. (see below)

9 Centennial
State:

9 Sesquicentennial

9 Bicentennial

Zip Code:

Zip Code:

Number of acres originally acquired: Number of retained acres actively farmed by a family member:*

* If less than 20 acres of original acquisition are retained, please provide documentation of the retained acres' annual gross farm income. **Centennial is 100 to 149 years; Sesquicentennial is 150 to 199 years; Bicentennial is 200 years & over. (See reverse side of application)

The following statement will appear on your Hoosier Homestead Award. So that we may personalize your award, please provide the requested information. Let it be recognized and celebrated that the
(insert desired family name)

Fam ily

has o wne d this
(insert county where farm is located)

County farm since

.

(insert year farm was originally purchased)

Please include with this application: 1) A copy of all instruments which document each transfer of ownership. The copy may be either of an original instrum ent, reco rds m aintained in a courth ouse, o r the pag e(s) from an abs tract of title cov ering the re al estate. The copies must demonstrate an unbroken familiar chain-of-title from the date that a member of your family originally acquired an interest in the real estate to the present. 2) A copy of the most recent property tax receipts. 3) The following information beginning with the original family owner and continuing to the present owner(s).
ACQUIRED FROM TRANSFERRED TO RELATIONSHIP TO PRESENT OWNER(S) DATE ACQUIRED

I certify that the a bove info rma tion is to the be st of m y knowled ge true a nd corre ct.
Print name of applicant: Address of applicant: Email Address: Signature of applicant: City: Day-time phone number: State: Date: Zip:

NOTICE: For those applicants that already received a Hoosier Homestead award and would like to have either the Sesquicentennial or Bicentennial award, you need only to supply ownership information as requested on the front of the application from the date you were awarded the Hoosier Homestead certificate to the present. GENERAL INFORMATION: Information requested on this page, while not essential to Hoosier Homestead certification, will be most valuable to future historians. The questions below are offered only as a guide. Please feel free to add any other data on additional sheets, especially family or pioneer stories concerning the farm and surrounding area.
1). From whom did the original family purchase the farm? 2). Wha t was the original per acre cost of the farm? 3). Where was the first family owner born? 4). Whe re did the original family owner live prior to moving onto the farm ? 5). Was this a homestead? 6). Did the first family owner farm the land? 7). Did the original owner engage in trades or occupations off the farm ? 8). Wha t improveme nts were mad e by the original family owner? 9). Is the original home, or any portion of it or other buildings, still standing or in use?

10). W hen wa s the pre sent ho me b uilt? 11). What are the farm's major crops or products?

PLEASE RETURN YOUR COMPLETED APPLICATION TO: Hoosier Homestead Program Office of the Commissioner of Agriculture ISTA Center - Suite 416 150 West Market Street Indianapolis, Indiana 46204-2810