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ADFP-2(Rev. 2-1-79) Attach to Wisconsin Income Tax Schedule FC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN Rustad Marvin J. (1) Name of Owner(s) (Last) (First) (Middle Initial) (2) Address 2932 CTH BN,, RFD #1, Cottage Grove, WI 53527 (3) Phone 873-3989 (4) Location of the land Town of Pleasant Springs Secs 1 & 12 6-N 11-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 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 June 6, 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) Parce( No. (from tax rolls) (9) Total Acres in parcel (10) Acres in Exclusive Ag. District 23-01-15 41. 0 41.0 23-01-16 39.0 39.0 23-12-246 41.2 41.2 ea: Total 121. 2 Total 121.2 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. 1 Date Program Year Signature of Zoning Authority Title 2. Date Program Year Signature of Zoning Authority Title 3 Date Program Year Signature of Zoning Authority Title 4. — Date Program Year Signature of Zoning Authority Title (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.)