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WIS ONSIN REAL ESTATE TRANSFER RETURN-CONFIDENTIAL Submit allparts to Registerof Deeds with document(s)to be recorded. I. RAk.OR: .^ V. PHYSICAL DESCRIPTION AND PRIMARY USE /1.Name Roderick :.eo Wale, t 15.Kind of property 16.Primary use /1. Address-New address if property transferred was residence . I ;:I Land only a.I Residential ;, _ r n Land and buildings I !Single family/condominium "t r eet I I Other(explain) I I Multi-family-/units `7, ac, 1 32571 17.Estimated land area and type I 'Time share unit 3. Grantor is I-•'Individual I I Partnership I I Corporation I I Other a. Lot size x b.1 I Commercial b. Total acres` c. [ � Manufacturing N. GRANTEE: b f1°"Ui0 ac-.7-ii'; 4. Name c ... u ;; anc . __�iec_ , lUL c. MFL/FC/WTLacres d.j I Agricultural business use 5.Property Address d. Ft.of water frontage Adjoining land? n Yes I I No e. I Other(explain) Clifton Road. VI.TRANSFER P- _irie du Sac, ;;" 5357f 18.Type of transfer: I 1 Sale Gift I I Exchange I I Other(explain) 6. Grantor/grantee related: None I Corp/Shareholder/Subsidiary I I Partnership 19.Ownershi interest transferred: Full Partial(explain) Financial[- I Family or Other,explain p ( D ) 20.Does the grantor retain any of the following rights?! I Life estate I 'Easement 7. Send tax bill to:Name and address 21.1 I Deed in satisfaction of original land contract? Dated? rar_t of . 22.Points(prepaid interest)paid by seller $ 23.Value of personal property transferred but excluded from(25) $ III.ENERGY 8. Is this property subject to the Rental Weatherization Standards,ILHR67? 24.Value of property exempt from local property tax included on(25) $ Yes 1 1 No Exclusion code `'r' If W-11,explain VII.COMPUTATION OF FEE OR STATEMENT OF EXEMPTION IV.PROPERTY TRANSFERRED 9. n City Village 1'- I Town Roxbur; 25.Total value of REAL ESTATE transferred $ County Dane 26.Transfer fee due(line 25 times.003) $ ^i I=:t°'' icUac 27.TRANSFER EXEMPTION NUMBER,sec.77.25 - 10.Street address 11.Tax parcel number 12.Lot no.(s) Blk.no.(s) 28. Grantee's financing obtained from a. Seller Plat name If box a or b is checked, b. Assumed existing financing complete Part VIII- c. Financial institution/Other 3rd party 13.Section Township Range Financing Terms d. No financing involved 14.Legal Description metes and bounds:(attach 4 copies if necessary) _..c »I. - l`. .._ ").:1;2 of _ilE r...L. - Se :, : . r !,3...`. .:i`. . T...-:.. (To,;-: : -- .. :. - F/-,i.;-: ; :---...1",:' "'est o_` t.Tl -. ti,:,m; E'^, r-1nt part co v ve 'i !- t - r c re.cardee 71.'.. Vol. 6 f Pare ? as Doc. 4917227 VIII.FINANCING TERMS(FOR SELLER/ASSUMED FINANCED TRANSACTIONS ONLY) 29.Total down payment $ (Line 29.Line 25 minus Lines 30a,b and c excluding payments for personal property) 30. Amount of mortgage/land 31.Interest 32.Principal and interest 33.Frequency 34.Length of 35.Date of any lump sum 36.Amount of lump contract at purchase rate(stated) paid per payment of pymts contract (balloon)payments sum a. $ % $ l I $ b. $ % $ I I $ c. $ % $ / / $ 37.If the dollar amount paid per payment(32)is scheduled to change(not as a result of a change in the interest rate),fill in the line letter from above . Enter the date of change / / and the amount it will change to $ . IX. CERTIFICATION We declare under penalty of law,that this return has been examined by us and to the best of our knowledge and belief it is true,correct and complete. Grantor or agent Date Grantor's telephone number SIGN j ( ) HERE Grantee or agent Date Grantee's telephone number ( ) Print name and address of grantor's agent Agent's telephone number ( ) Document number----•--.-- -- Vol/Jac. !Pape/Im. Date recorded Date and kind of conveyance I Com code i I 1 1 2 3 4 LEAVE Parcel number Assmt.year 19 _ Field • Sales number THIS L County _ _ I I Use AREA Parcel classification I Tax dist _ _ _ _ _ BLANK RES COM MFG AGR S/W FOR T Assmt.dist. _ _ Reject 1 2 3 4 5 6 Wisconsin Department of Revenue PE-500(R.5-92) PROPERTY OWNER'S COPY