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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: % /2 2 <br />Landownerform on: <br />Name: / T <br />Address: /7 or City: <br />Daytime phone: 6 or- _ <br />Fax: Go $ ceY SC 3 <br />Zip Code: 5353/ <br />E-mail: <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 s,pecific pos Ie)' y <br />Property address: yyr / L! <br />Tax Parcel lD #: 6)6 c2/6 J / (2— — o20 ,rS0v -- 7 <br />Le al description of property: / <br />% 1/4 of/�w 1/4, Section �/ , Town of /fete°-1 <br />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 3-6 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 />S:\PlanDev\Zoning\ZLR\Forms, Applications & Informational Materials\Parcel status application.doc <br />