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• Attach to Wisconsin Income Tax Schedule FC ZONING CERTIFICATE - FARMLAND PRESERVATION ACT - STATE OF WISCONSIN (1) Name of Owners(s) STATZ EDMUND L. (Last) (First) (Middle Initial) (2) Address 5946 STATZ ROAD, CROSS PLAINS, WI (3) Phone 608-798-2812 (4) Location of the land TOWN OF SPRINGFIELD 07 08T 08R DANE Town, Village, or City Section, Township, Range County (If part of the owner's farmland is located in another town,village,or city,submit information about that farmland on a separate form) EXCLUSIVE AGRICULTURAL ZONING (5) DANE COUNTY has an exclusive agricultural zoning ordinance which has been certified (County,Town,Village or City) by the State Agricultural Lands Preservation Board. On (date) 12/04/81 (6) Check below the type of ordinance jurisdistion which applies and give the date of local approval(effective date of ordinance). Town under county county exclusive agricultural zoning. Local approval date Town with separate town ordinance. Local approval date 04/16/79 (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) Parcel No.(from tax rolls) (9) Total acres in Parcel (10) Acres in Ex. Ag. District (11) Are improvements in Ex. Ag. Zoning District 0808-072-9000-4 35.6000 35.6000 NO 0808-072-8720-5 10.0000 10.0000 NO 0808-072-9500-9 40.0000 40.0000 NO 0808-074-8510-7 24.8000 24.8000 YES 0808-071-9000-5 39.6000 39.6000 NO 0808-072-8220-0 11.7500 11.7500 NO 0808-074-8825-7 .9300 .9300 YES TOTAL 162.6800 TOTAL 162.6800 AGRICULTURAL PRESERVATION PLAN AND SOIL AND WATER CONSERVATION STANDARDS (12) DANE County has adopted an agricultural preservation plan which was certified on(date) 12/4/81 by the State Agricultural Lands Preservation Board. DANE County has adopted a soil and water conservation policy which was approved by the State Land Conservation Board on(date) 4/8/86. No notice of noncompliance is in effect for lands hereby certified. CERTIFICATION (NOTE: IF ANY OF THE ABOVE INFORMATION HAS CHANGED PLEASE SUBMIT A NEW ZONING CERTIFICATE.) The undersigned Zoning Authority hereby certifies that the zoning information contained on this form is true and correct on the most recent date shown below. The undersigned Land Conservation Committee (LCC) Authority hereby certifies the above landowner's notification of intent to submit a claim under subch. IX, ch. 71, Wis. Stats. 01/03/95 01/03/95 0000 Signature of Zoning Authority Date Signature of LCC Authority Date Program Year (The land must be in a certified 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 a farmland preservation credit claim is filed with the Wisconsin Department of Revenue). ARM-LR-2 (Rev 9/92)