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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 (1) Name of Owner(s) Herbrand Richard (Last) (First) (Middle Initial) (2) Address 6673 STH 12, R#l, Dane, WI 53529 (3) Phone 643-3868 (4) Location of the land Town of Roxbury Secs 26 & 35 9N 7E 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 fonn.) 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 July 10, 1982 (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 25-26-568 40.1 40.1 25-26-569 40.0 40.0 25-35-733 39.9 39.9 25-35-734 40.1 40.1 Total 160.1 Total 160.1 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 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. . Signature of Zoning Authority Title Date Program Year Signature of Zoning Authority Title Date Program Year 3' Title Date Program Year Signature of Zoning Authority 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.)