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AD.FP_ Jj 5y.2-1/91 _. Attach to Wisconsin Income Tax Schedule FC ZOIJING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN Clark R. Donald (1) Name of Ovner(s) Klipstein Harland (Last) (First) (Middle Initial) (2) Address P.O. Box 5566, Madison, WI 53705 (3) Phone 238-7181 (4) Location of the land Town of Dane Secs 8, 16, 17 9-N 8-E Dane Town, Village,or City Section,Township, Range County (If part of the owrer'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 bcated in a town, has the town adopted the county exclusive agricultural zoning ordinance? Yes X No Date of Town Approval June 28, 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 11-16-342 30.00 30.00 11-16-343 40.20 40.20 11-08-183 40.00 40.00 i." .- 11-16-341 40. 10 40.10 __ 11-17-357 40.00 40.00 11-16-346 40.30 40.30 . - y Total 230.60 Total 230.60 - 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 • 1 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. 1 Date Program Year Signature of Zoning Authority Title 2' Title - Date Program Year Signature of Zoning Authority 3. Date Program Year Signature of Zoning Authority 4 Title Date Program Year, Signature of Zoning Authority (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.)