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RECEIVED <br /> o a Dane County Department of Planning & Development <br /> Application for Determination of Parcel Status t 9 MI <br /> Date: /Oh 9/0. Ceceirallgit # <br /> Landowner informs on: <br /> Name: Ve'NO/t) Z-) Ck:ec2T S-) -�-. <br /> Address: i.�D 9 L36- Hwy 73 City: E,e�/£c4 Zip Code: 5k 5-3 / <br /> Daytime phone: <br /> Fax: E-mail: <br /> Applicant information (if df om landowner): <br /> Name: , 7iG,�zL-ec. d -different u /°<" <br /> Address:/d, I City: 04-14 ,,i (aye Zip Code: .5352-_3 <br /> Daytime phone: 6,0 l c' Z-3 3 7--s-94 <br /> Fax: /jr" .S'70 E-mail: /'12 11$1/ fo /l(r-ts/,)I/A1-r-v. (o"'? <br /> Relationship to landowner: nylci-oveti fo II- 15 e — <br /> Are you submitting this application as an authorized agent for the landowner? Yes 1/No <br /> Property information (be as specific as possible): <br /> Property address: G/SO F 514- /-4-CA/ -7 3 / jO r <br /> Tax Parcel ID#: ‘e 1° , ,1-c 6c d <br /> Legal description of property: -e -e <br /> 1/4 of 1/4, Section , Town of OR <br /> Lot(s) , Block , Plat of <br /> Sketch map provided? Yes V No Rumpf <br /> Law Office,S.C. Michael D. Rumpf <br /> Additional information (optional): Attorney <br /> Name(s) of previous owner(s) (if known): <br /> Comments: <br /> 152 W.Main Street I P.O.Box 1 I Cambridge,WI 53523 <br /> 608.423.3254 I fax 608.423.4570 I mrumpf @rumpflaw.com <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/scw1/Parcel_status_application.doc Page 2 of 2 Revision 1.20.2010 <br />