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esDane County Department of Planning & Development : Application for Determination of Parcel Status 4C s Date: " ic/ i rj Receipt # Landowner information: Name: D t L x RFS eI Address: 12q J./ DD City: j(GL iE t ZieZip Code: 5-3cok Daytime phone: Fax: E-mail: Applicant information (if different from landowner): Name: 1 6 N/aL J 1-/6 Address: 40302 /%tv y q2 City: P/66114,y,t; Zip Code: 53:$-2 I Daytime phone: (o 6a _ 4/3y 5- Fax: E-mail: j-/ 6 f 3.-'7 % 4l 6L IC- o t1 Relationship to landowner: Nil p,JEt Are you submitting this application as an authorized agent for the landowner? Yes X( No Property information (be as specific as possible): Property address: Tax Parcel ID#: 456 - 363 -- 27 3 0 -7 e5 k-363 -2566 -5 QjZ g-357466- Legal description of property: 3531 , w 1/4 of S it, 1/4, Section , Town o 1/1 0�fi/r G s° R Lot(s) , Block , Plat of Sketch map provided? Yes No Additional information (optional): Name(s)of previous owner(s) (if known): /14 R L tt' 5i. Comments: bi LE% (5-1- irci ,fl"I 24t-f- iyje J-/u 4c1 Aa )J # e ES fv N's £-111f? D(<oA'Fj' Atli) LA) t 6 De E50cs ,9AJ ? 4/04etL(S -fin / ' ' n 4- --tfrf2 uR07/-I fr 4of5Ly /HLeiCE d,s/4.1"1- / so47" 7 D - oN .. /1 try t4 ,e( /3 el -1eE k gfk c • Important Notice: A Dane County parcel status determination is preliminary in nature and only determines if a parcel of land was created in accordance with Dane County ordinance provisions. Additional title history research conducted by a title company may be necessary to verify parcel status. Dane County and its staff are not responsible for any misrepresentation or mischaracterization of the information contained in the parcel status determination. Please allow 1-3 weeks to process your request. A copy of the report will be mailed to the landowner, the applicant(if different from the landowner)and the town clerk. http://dcinet/uploads/imservicerequest/scwl/Parcel_status_application.doc Page 2 of 2 Revision 1.20.2010