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ARM-LR-2 (Rev. 11/83) <br /> Attach to Wisconsin Income Tax Schedule FC <br /> ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN <br /> (1) Name of Owner(s) Homburg Bruce <br /> (Last) (First) (Middle Initial) <br /> (2) Mailing Address <br /> of Owner 6002 Milwaukee St. , City ZIP Code (3)Phone 244-6405 <br /> (4) Location of the land Town of Cottage Grove 7 T7N R11E 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) 9/1R/7R <br /> (6) Check below the type of ordinance jurisdiction which applies and give the date of local approval (effective date of ordinance). <br /> © Town under county exclusive agricultural zoning. Local approval date May 15. 1982 <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 /> nExtraterritorial. 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 ❑ <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 /> 0711-073-9000-8 2 0. 0000 20.0000 <br /> 0711-073-9530-7 3 8. 1.600 38. 1E;00 <br /> Total 58.16 Total 58. 16 <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 Land Conservation Board. <br /> CERTIFICATION <br /> Signature of Zoning Authority Program Year <br /> Title ZONING ADMINISTRATOR Date <br /> RECERTIFICATION <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 shown below. <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 />