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'ADFP-21Rev.3.1.78) • • Attach to Wisconsin Income Tax Schedule FC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN Houfe Alma H. (1) Name of Owner(s) . (Last) (First) (Middle Initial) (2) Address _ 1852 Emerald Terrace, Edgerton; WI 5-35-34 (3) Phone 884-8780 (4) Location of the land Town of Albion Sec 21 5—N 12—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 X No Date of Town Approval June 29, 1979 (7) Does each structure or improvement on the land conform to the requirements of the exclusive agricultural zoning ordinance? Yes X No 'I Land on which tax credit is claimed: ti (8) Partel No. (from tax rolls) (9) Total Acres in parcel (10) Acres in Exclusive Ag. District 01-01-384.2 - 7.45 6.30 01-01-383 5.70 5.70 9 01-01-196 20.00 " 20.00 01-01-196.1 5_6n 5.60 01-01-196.2 19.00 19.00 01-01-196.3 24.00 24.00 } 01-01-196.4 21.00 21.0n • 01-01-196.5 13.00 13.00 1_ / (� � g Lo tiko SS Total 115.75 Total 114.60 - 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 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. Program Year Signature of Zoning Authority Title • 3 Date Program Year Signature of Zoning Authority Title 4. Title Date Program Year Signature of Zoning Authority ' (The land must be in an exclusive agricultural zone on Dec. 31 of the year Jiff which credit is being claimed. This certificate, along with property tax bills, must be included with the Schedule PC when credit claim is filed with the Wisconsin Department of Revenue.)