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1 .} Page 2 of 2 <br /> :2(Rev. 11/83 ) —Attach to Wisconsin Income Tax Schedule FC . <br /> ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN. <br /> 441) Name of Owner(s) Jacobson Wayne R. & Janet J. <br /> (Last) (First) (Middle Initial) <br /> (2) of Owner adress R#1, 2050 Rinden Road, Cottage Gr. 53527 <br /> ZIP Code (3)Phone <br /> (4) Location of the land Town of Pleasant Springs <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) 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) • <br /> (6) Check below the type of ordinance jurisdiction which applies and give the date of local approval (effective date of ordinance). <br /> PITown under county exclusive agricultural zoning. Local approval date <br /> II Town with separate town ordinance. Local approval date <br /> L_l City or village: Check one or both below. <br /> Within corporate limits. Local approval date <br /> 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 I XI 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 /> 23-23-518 40.0 40.0 <br /> 23-23-519 39.5 39.5 <br /> 23-23-530 39.7 39.7 <br /> 23-23-531 39.1 39.1 <br /> 23-11-221 40.50 40. 50 <br /> 23-11-222 33.10 33.10 *`'` <br /> 23-11-225 27.30 27.30' • <br /> 23-03-55 <br /> 9.0 9.0 <br /> 23-03-56 29.5 29.5 <br /> 23-10-199 41. 3 41.3 <br /> Total 854.2 Total 854.2 • <br /> AGRICULTURAL PRESERVATION PLAN '? f <br /> (11) <br /> County has adopted an agricultural preservation plan which was ce'sif`-r <br /> on (date) by the State Land Conservation Board. t s <br /> ` <br /> CERTIFICATION <br /> Signature of Zoning Authority Program Year <br /> Title f i+. ", <br /> Date <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 shown•a <br /> • <br /> Rf R <br /> Signature of Zoning Authority Title Date Progra `R • <br /> � ; <br /> 2. ¢. <br /> Signature of Zoning Authority Title Date Pp.!' ).' <br /> 3. <br /> Signature of Zoning Authority Title Date p ' <br /> 4. • - ' t • <br /> Signature of Zoning Authority Title Date ;``7* , <br /> (The land must be in an exclusive agricultural gricultural zone on Dec 31 of the year for which credit is being claimed This c • <br /> with property tax bills,must be included with the Schedule FC when credit claim is filed with the TVisconsin Department of <br />