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ADFP-2 (rev.3-1-78) Attach to Wisconsin Income Tax Schedule FC' ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN (1) Name of Owner(s) _ I1oen_______ Rodger (Last) (First) (Middle Initial) (2) Address — RFD #J1 1479 Hommen Road, Deer fi old, WI 53531 (3) Phone _ 764-5135 (4) Location of the land _ Town of Deerfield Secs 1[3 & 19 7—N 12—E 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 inforntation 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. (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 October 26, 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) Parcel No. (from tax rolls) (9) Total Acres in parcel (10) Acres in Exclusive Ag. District 0712-191-8500-0 4. 5000 4. 5000 0712-191-8000-5 1 8. 90 00 18.9000 0712-184-9340-1 1. 5000 1• 5000 0712-192-3500-9 31.2000 31. 2000 0712-193-850 0-8 12. 2000 12.2000 0712-192-9000-2 25.8000 :5.3000 0712-192-9500-7 39. 7000 39. 7000 0712-192-8200-2 16.4000 16.4000 0712-193-3000-3 3 7. 6000 37. 60/0 Total 187.8 Total 187.8 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-CERTI FICATION (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. 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.)