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Dane County Department of Planning & DevelopMLECEIVED <br /> ; ' Application for Determination of Parcel Status <br /> OCT 32016 <br /> Date: 06/2)(6, RPetfpcOuNTY PLANNING&DEVELOPMENT <br /> Landowner i fo mation: r <br /> Name: f34 'v /1. 7.,1 CA 4412/0 _2/.5c7 - <br /> Address?33 '� /�tt ✓ ' Zip Code: c3 Cry <br /> Daytime phone: 4"..1-4Ne pt <br /> Fax: E-mail:/(/e C A-%e- 7 2-,S-- ? 4 a tie e. ,vef <br /> Applicant information (if differen from landowner): <br /> Name: /7776 ,41f.c_ Ad_ _ <br /> Address:/C)d6 City:arl,fe / ye- Zip Code: S---3,S-2. <br /> Daytime phone: <br /> Fax: 2-3 $--7& E-mail: ll/7/f/Gtf--1�"` )�GCS .li � Cdr <br /> Relationship to landowner: fl4'7-1402,v ecs e- >4_ <br /> Are you submitting this application as an authofized agent for the landowner? Yes , i o <br /> Property information be as specif' s ossib e): <br /> Property address: 3 -4 3 ?j C 7‘u/ t7 /3 r <br /> Tax Parcel ID#: 5 0 J / d / 2_z_ — <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 <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/uploads/imservicerequest/scwl/Parcel_status_application.doc Page 2 of 2 Revision 1.20.2010 <br />