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AOFP TIP Rev.x1.79) ALSO: Cross Plains A Attach to Wisconsin Income Tux Schedule PC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN (1) Name of Owner(s) Mickelson Craig &Merrill (Last) (First) (Middle Initial) (2) Address 9625 Union Valley Road, Black Earth, WI 53515 (3) Phone 767-3428 (4) Location of the land Twon of Vermont �_-.—_Sec 12 7-N 6-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 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. (6) If the land is located in a town,has the town adopted the county exclusive agricultural zoning ordinance? Yes ___. _.._.. --__ R No _ Date of Town Approval _ October 12, 1979 (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 0706-123-9500-3 40.0000 40.0000 0706-124-8000-9 3 5.00 00 35.0000 0706-124-9000-7 40.0000 40.0000 0706-124-9500-2 4-0.0000 40.0000 Total 155.0 Total 155.0 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 aoricultural 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-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 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.)