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NPS Form 10-900 OMB No. 10024-0018 (Oct. '990) United States Department of the Interior 18 National Park Service National Register of Historic Places Registration Form This form is for use in nominating or requesting determinations for individual properties and districts. See instructions in How to Complete the National Register of Historic Places Registration Form(National Register Bulletin 16A). Complete each item by marking "x" in the appropriate box or by entering the information requested. If an item does not apply to the property being documented, enter "N/A" for"not applicable." For functions, architectural classification, materials, and areas of significance, enter only categories and subcategories from the instructions. Place additional entries and narrative items on continuation sheets(NPS Form 10-900a). Use a typewriter, word processor, or computer,to complete all items. 1. Name of Property historic name Jacob Jackson Farm other names/site number Maple Hill (preferred) 2. Location street & number S.R. 1002, .4 mile west of S R 1538 ❑ not for publication city or town Hillsborough ❑ vicinity state North Carolina code NC county Orange code 135 zip code 27278 3. State/Federal Agency Certification As the designated authority under the National Historic Preservation Act, as amended, I hereby certify that this ❑ nomination ❑ request for determination of eligibility meets the documentation standards for registering properties in the National Register of Historic Places and meets the procedural and professional requirements set forth in 36 CFR Part 60. In my opinion,the property ❑ meets ❑ does not most the National Register criteria. I recommend that this property be considered significant ❑ nationally ❑ statewide ®locally. (❑ See continuation sheet for additional comments.) Signature of certifying official/Title Date State of Federal agency and bureau In my opinion, the property ❑ meets ❑does not meet the National Register criteria. (❑ See continuation sheet for additional comments.) Signature of certifying official/Title Date State or Federal agency and bureau 4. National Park Service Certification I hereby certify that the property is: Signature of the Keeper Date of Action C entered in the National Register. I- See continuation sheet. determined eligible for the National Register See continuation sheet. r determined not ehoible for the National Register L removed from the National Regisser otner. tetpla n)