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Attach to Wisconsin Income Tax Schedule FC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN (1) Name of Owner(s) Ames Paul M. (Last) (First) (Middle Initial) (2) Address 102 N. First Street, RFD #2, Brooklyn, WI 53521 455-3973 (3) Phone (4) Location of the land Town of Rutland Secs 30, 31, 32 Dane Town, Village,or City Section, Township, Range County (If part of the owner's farmland is located in another town, village, or city,please submit information about that farmland on a separate form.) EXCLUSIVE AGRICULTURAL ZONING (5) Dane has an exclusive agricultural zoning ordinance which has been certified (County, Town, Village or City) by the State Agricultural Lands Preservation Board. (6) If the land is located in a town, has the town adopted the county exclusive agricultural zoning ordinance? Yes X No Date of Town Approval June 7, 1978 (7) Does each structure or improvement on the land conform to the requirements of the exclusive agricultural zoning ordinance? Yes X No Land on which tax credit is claimed: (8) Parce(No. (from tax rolls) (9) Total Acres in parcel (10) Acres in Exclusive Ag. District 0510-304-9570-5 33.6000 33.6000 0510-311-8120-2 .1000 .1000 0510-311-8500-2 4-0.6000 40.6000 0510-311-8000-7 40.7000 40.7000 0510-311-9500-0 34. 8000 34.8000 0510-311-9000-5 16.5000 16.5000 0510-322-8590-1 24.9000 24.9000 0510-322-9030-6 29.3000 29.3000 - Total 220. 5 Total 220. 5 AGRICULTURAL PRESERVATION PLAN (11) _ Dane County has adopted an agricultural preservation plan which was certified (date) 12/4/81 by the State Agricultural Lands Preservation Board. Is all of the owner/applicant farmland located in an agricultural preservation district under the certified county preservation plan? Yes No If NO, how many acres are in the preservation district? CERTIFICATION Signature of Zoning Authority: _ Program Year — Title: ZONING ADMINISTRATOR Date: RE-CERTIFICATION (Note:If any of the above information has changed,please submit a new zoning certificate.) The undersigned hereby certifies that the information contained on this form is true and correct on the most recent date shown below. 1. __ Signature of Zoning Authority Title Date Program Year 2. __ Signature of Zoning Authority Title Date Program Year 3. Signature of Zoning Authority Title Date Program Year 4. Signature of Zoning Authority Title Date Program Year (The land must be in an exclusive agricultural zone on Dec. 31 of the year for which credit is being claimed. This certificate, along with property tax bills, must be included with the Schedule FC when credit claim is filed with the Wisconsin Department of Revenue.)