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1 <br /> I II <br /> ARM-LR-2(Rev. 11/83) } ` <br /> Attach to Wisconsin Income Tax Schedule FC 51 Z 9/ i D t S <br /> ZONING CERTIFICATE - FARMLAND PRESERVATION ACT - STATE OF WISCONSIN <br /> (1) Name of Owner(s) Affholder Donald <br /> (Last) (First) :(Middle Initial) <br /> (2) Mailing Address <br /> of Owner 6176 CTH TT, Marshall, WI ZIP Code 53559 (3)Phone 655-3789 <br /> (4) Location of the land Town of Medina Secs 4, 5 8N 12E Dane <br /> Town,Village,or City Section,Township, Range County <br /> (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.) <br /> EXCLUSIVE AGRICULTURAL ZONING <br /> • (5) Dane has an exclusive agricultural zoning ordinance which has been certified <br /> (County,Town,Village or City) <br /> by the State Land Conservation Board on (date) 5/18/78 • <br /> (6) Check below the type of ordinance jurisdiction which applies and give the date of local approval (effective date of ordinance). <br /> XI Town under county exclusive agricultural zoning. Local approval date October 1, 1980 <br /> nTown with separate town ordinance. Local approval date <br /> City or village: Check one or both below. <br /> nWithin corporate limits. Local approval date <br /> II Extraterritorial. Local approval date <br /> (7) Does each structure or improvement on the land conform to the requirements of the exclusive agricultural zoning ordinance? <br /> Yes ® No n <br /> Land on which tax credit is claimed: <br /> ' (8) Parcel No. (from tax rolls) (9) Total Acres in Parcel (10) Acres in Exclusive Ag. District <br /> 0812-054-8000-9 40.3000 40.3000 <br /> 0812-054-8500-4 20.2000 20.2000 <br /> 0812-051-9870-8 .3000 .3000 <br /> 0812-042-9000-1 33. 7000 33.7000 <br /> 0812-043-8500-7 22.0000 22.0000 <br /> 0812-043-8280-4 17.9000 17.9000 <br /> 0812-043-9000-0 21.0000 21.0000 <br /> 1 0812-043-9190-1 12.8000 12.8000 <br /> 0812-054-8570-0 20.2000 20.2000 <br /> \ 0812-054-9000-7 26.9000 26.9000 <br /> 0812-054-9220-1 1 0. 7000 10.7000 <br /> 1 0812-054-9500-2 24.9000 24.9000 <br /> t 0812-054-9910-6 5.0000 5.0000 <br /> { <br /> Total. 255.9 Total 255.9 <br /> AGRICULTURAL PRESERVATION PLAN <br /> (11) Dane County has adopted an agricultural preservation plan which was certified <br /> on (date) 12/4/81 by the State end C• servation Board. <br /> C RTI F .CAT ‘6 N <br /> Signature of Zoning Authority <br /> Program Year <br /> Title ZONING ADMINISTRATOR �' Date 1 <br /> RE-CERTIFICATION <br /> (Note:If any of the above information has changed,please submit a new zoning certificate.) . <br /> The undersigned hereby certifies that the information contained on this form is true and correct on the most recent date shqwn below. <br /> i <br /> 1. <br /> Signature of Zoning Authority Title Date Program Year <br /> 2. <br /> Signature of Zoning Authority Title Date Program Year <br /> 3. <br /> Signature of Zoning Authority Title Date Program Year <br /> 4. <br /> Signature of Zoning Authority Title Date Program Year <br /> (The land must be in an exclusive agricultural zone on Dec. 31 of the year for which credit is being claimed. This certificate, along <br /> with property tax bills, must be included with the Schedule FC when credit claim is filed with the Wisconsin Department of Revenue.) <br />