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' Dane County Department of Planning & Development <br /> o 'v14 Application for Determination of Parcel Status <br /> • -DOO /Alf <br /> Date: 3-/6( Receipt #06144J /0 <br /> Landoww information <br /> Name: L/O h✓1 C• JJM'US <br /> Address: WV obicifvotimi fO( City: Cv1S /Oh ukij Zip Code: S3,54 <br /> Daytime phone: 6,0� i ff- /V4 <br /> Fax: E-mail: x(//CLA?dJ q l //U% C <br /> Applicant information (if different from landowner): <br /> Name: <br /> Address: City: Zip Code: <br /> Daytime phone: <br /> Fax: E-mail: <br /> Relationship to landowner: <br /> Are you submitting this application as an authorized agent for the landowner? Yes No_ <br /> Property information (be as specific as possible): <br /> Property address: / <br /> Tax Parcel ID#: (2 ) 07 ' / O3 <br /> Legal description of property: <br /> 1/4 of 1/4, Section , Town of OR - <br /> Lot(s) , Block , Plat of <br /> Sketch map provided? Yes No JA I' 2014 <br /> Additional information (optional): <br /> Name(s) of previous owner(s) (if known): <br /> Comments: <br /> Important Notice: A Dane County parcel status determination is preliminary in nature and <br /> only determines if a parcel of land was created in accordance with Dane County ordinance <br /> provisions. Additional title history research conducted by a title company may be necessary to <br /> verify parcel status. Dane County and its staff are not responsible for any misrepresentation or <br /> mischaracterization of the information contained in the parcel status determination. <br /> Please allow 1-3 weeks to process your request. A copy of the report will be mailed to the landowner, <br /> the applicant(if different from the landowner) and the town clerk. <br /> http://dcinet/uploadsfimservicerequest/scwl/Parcel_status_application.doc Page 2 of 2 Revision 1.20.2010 <br />