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ADFP 2(Aw. 2 1 79) Attach to Wisconsin Inemne Tax Schedule PC ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN (1) Name of Owner(s) Jenson Monica (Last) (First) (Middle Initial) (2) Address ___R#2, 2046 E. Blue Mounds Road, Mt. Horeb, WI (3) Phone 437-8653 (4) Location of the land—_____Town of Blue Mounds .—_ Secs 25 26 6-N 6-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? X No Date of Town Approval __August 26, 1980 (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 • 05-25-530 40.20 40.20 05-25-527 40.30 40. 30 05-26-557 40.00 — 40.00 - 05-26-556 40.00 40.00 05-26-544 —__ 40.10 40.10 • Total 200.60 Total 200.60 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 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. Signature of Zoning Authority Title • Date Program Year 2. — — -- — — Signature of Zoning Authority Title Date Program Year 3. -- --- —.. --_..--. - Signature of Zoning Authority Title Date Program Year 4. — — — — Signature of Zoning Authority Title Date Program Year (Tire land must he in an exclusive agricultural zone on Dec. 31 of the year for which credit is being claimed. This certificate, along Ii'ith property tax bills, must be included with the Schedule PC when credit claim is filed with the Wisconsin Department of Revenue.)