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Aurr-,c 1nev. <br /> Attach to Wisconsin Income Tax Schedule FC <br /> ZONING CERTIFICATE — FARMLAND PRESERVATION ACT — STATE OF WISCONSIN <br /> Olson Walton & Bernice <br /> (1) Name of Owner(s) <br /> (Last) (First) (Middle Initial) <br /> (2) Address <br /> R#2, Box 52-K, Brooklyn, WI 53521 (3) Phone 455-8971 <br /> (4) Location of the land Town of Rutland Sec 29 5-N 10-E Dane <br /> Town, Village,or City Section,Township, Range County <br /> (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.) <br /> EXCLUSIVE AGRICULTURAL ZONING <br /> (5) Dane has an exclusive agricultural zoning ordinance which has been certified <br /> (County, Town, Village or City) <br /> by the State Agricultural Lands Preservation Board. <br /> (6) If the land is located in a town, has the town adopted the county exclusive agricultural zoning ordinance? <br /> X 7, 1978 <br /> Yes No Date of Town Approval <br /> (7) Does each structure or improvement on the land conform to the requirements of the exclusive agricultural zoning ordinance? <br /> ' .- X N o <br /> Yes <br /> Land on which tax credit is claimed: <br /> (8) Parcel No. (from tax rolls) (9) Total Acres in parcel (10) Acres in Exclusive Ag. District <br /> 26-29-655 40.00 40.00 <br /> 26-29-656 23.00 23.00 <br /> • <br /> Total 63.00 Total <br /> 63.00 <br /> AGRICULTURAL PRESERVATION PLAN <br /> (11) - Dane County has adopted an agricultural preservation plan which was certified <br /> (date) 1 /4/81 by the State Agricultural Lands Preservation Board. Is all of the owner/applicant farmland <br /> located in an agricultural preservation district under the certified county preservation plan? <br /> Yes No If NO, how many acres are in the preservation district? <br /> CERTIFICATION <br /> Program Year - <br /> Signature of Zoning Authority: <br /> Title: ZONING ADMINISTRATOR Date: <br /> RE-CERTIFICATION <br /> (Note:If any of the above information has changed,please submit a new zoning certificate.) <br /> The undersigned hereby certifies that the information contained on this form is true and correct on the most recent date shown below. <br /> 4F 1. -- • <br /> Signature of Zoning Authority <br /> Title Date Program Year <br /> 2. -- Title Date Program Year <br /> Signature of Zoning Authority <br /> 3' Title Date Program Year <br /> Signature of Zoning Authority <br /> 4. Date Program Year <br /> Signature of Zoning Authority Title <br /> (The land must be in an exclusive agricultural zone on Dec. 31 of the year for which credit is being claimed. This certificate, along <br /> with property tax bills, must be included with the Schedule FC when credit claim is filed with the Wisconsin Department of Revenue.) <br />