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Attach to Wisconsin Income Tax Schedule FC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN (1) Name of Owner(s) Farris James R. (Last) (First) (Middle Initial) (2) Mailing Address of Owner 4925 Oak Park Rd. , Marshall, WI 53559ZIP Code 53559 655-3537 (3)Phone (4) Location of the land Town of Medina Secs 29, 32 8N 12E 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 Land Conservation Board on (date) May 18, 1978 (6) Check below the type of ordinance jurisdiction which applies and give the date of local approval (effective date of ordinance). IX I Town under county exclusive agricultural zoning. Local approval date October 1, 1990 Town with separate town ordinance. Local approval date II City or village: Check one or both below. I I Within corporate limits. Local approval date II Extraterritorial. Local approval date (7) Does each structure or improvement on the land conform to the requirements of the exclusive agricultural zoning ordinance? Yes I X I No I I Land on which tax credit is claimed: (8) Parcel No. (fr rr-tsx t s) (9) Total Acres in Parcel (10) Acres in Exclusive Ag. District 0812-203-9500-1 17. 5000 17.5000 0812-203-9500-1 30.0000 30.0000 0812-203-9500-1 ' 40.0000 40.0000 Total 87.5 —_--__Total__ 87.5 AGRICULTURAL PRESERVATION PLAN (11) Dane County has adopted an agricultural preservation plan which was certified on (date) 12/4/81_ by the State Land Conservation Board. SOIL AND WATER CONSERVATION POLICY (12) Dane _ County Land Conservation Committee has adopted a soil and water conservation policy which was approved on (date) —__Apri1 6, 1986 _ by the State Land Conservation Board. No notice of noncompliance is in effect for lands hereby certified. CERTIFICATION Signature of Zoning Authority Program Year Title ZONTNGA_DM�NISTRATOR _ 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.)