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Dane County DepartmentPlanning of & De aliTf en %" <br />Application for Determination of Parcel Status <br />.4r4,0Si ptANNING ::17PNIENT <br />431, <br />DANECOUNT`(Date: ////I Receipt #250 <br />Landowner information: <br />Name: C 4_ c- t s 12u. %< <br />Address: 5D a2ek fcr51 , o/e( Cf. City: / PyZip Code: 5'3 5-3 4-/ <br />Daytime phone: (60 &) ' y - & sec <br />Fax: E-mail: t•(e sdcc, <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 specific as possible): <br />Property address: 5-3e l'ee 4, -1-e '-5 k m a4-e G-74, <br />Tax Parcel ID#: Pc,-/erSk,'/xi 03/2_—Za3- 7-0 <br />eC.4.77LurK,� Ili? qs SZZ3 S-0Z - <br />Legal description of property: <br />1/4 of 1/4, Section 2L , Town of At fi g t OR C_Si 2 - Z 2.3 - 50z) - 3 <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): )0e.,r y / <br />aro 7Lc r\ <br />Comments: Cu,zsz r-rr ie. -2 ( o) ('rz,tor;e_ <br />t_ o'r .59 (Dull-cr.) Rt_.f3,45 5 E3S0k4'S PL .T ot= <br />ID I9So <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 />