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ADFP-2(Rev,3-1-78) 4 c1 Attach to Wisconsin Income Tax Schedule PC ALSO: Christiana ZONING CERTIFICATE - FARMLAND PRESERVATION ACT - STATE OF WISCONSIN (1) Name of Owner(s) Mi kkel son Morris F. (Last) (First) (Middle Initial) (2) Address _ R#1 , 861 Hwy. 12-18, Deerfield, WI (3) Phone 764-5689 _ (4) Location of the land Town of Deerfield Sec 33, 34 7N-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 Jonn.) 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 0712-343-9660-1 1 0.0000 10.0000 0712-334-9000-0 22.0000 22.0000 0712-334-8 580-1 32. 8000 32.3000 0712-334-8000-2 2 9.4000 29.4000 • Total 94.2 Total 94.2 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 Program Year — Signature of Zoning Authority: 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. 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 inns! he in an exclusive agricultural zone on Dec. 31 of the year JOr which credit is being claimed. This certificate, along with property tax hills, must be included with the Schedule PC when credit claim is filed with the Wisconsin Department of Revenue.)