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01/16/2008 23:11 608-267-1540 DANE CU h'L(NNINU utv <br />rHuc vi, vc <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date:/ /g- <br />Landowner information: <br />Name: / -44.--1f /I 4 <br />Address: / -teat City: <br />Daytime phone: <br />E-mail: <br />Price: $100 <br />(Effective: 1-1-08) <br />Check made payable to <br />"Dane County Treasurer." <br />Fax: <br />Applicant Information (if different from landowner): <br />Name: g. 1. `aDe, rka tt <br />Address: G,/-S 114iti 1Al-, • City: v r'L t e. Zip Code: 3,57-% <br />Daytime phone: 7.5- <br />Fax: 6 - 7' - ji12 E-mail: _ <br />Relationship to landowner iZv-0. 49,v <br />Are you submitting this application as an authorized agent for the landowner? Yes No__ <br />Property information (be as specific a possible): <br />Property address: V4 <br />Tax Parcel ID #:� .e) �C 7/C2 3/-- 9200 - 0 <br />Legal description of property: 6 ° "2/ o 5,' %/ 9e5 — 6 <br />1/4 of 1/4, Section , Town of 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:, �'f� -4 <br />otzaehev Ae;,, Akeiu.e <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 />SAPIanDov\ZonincjaLR\Forms. Applications & Informational Matarials\Pa►cef status application.doc <br />FEB - 1 <br />DANE COUNTY PLANNING & DEVELCPM NT <br />