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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />p 3q <br />COSS'" <br />Date: ,/ S/ <br />Landowner information: e <br />0' % 0 <br />Name: <br />Address: o �0 K ) 4 City: Zip Code: S33-2 3 <br />Daytime phone: 6 Dg-- 7/ Z— 39 0 <br />Fax: E-mail: <A © he le r CQ y14 Do, Col-, <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 spfic as pos ible): <br />Property address: (o 2e ip U ✓D 4 (/ <br />02y/62/2 - 2j-,‘ -t <br />Tax Parcel ID #: <br />Legal description of property: <br />S 6 1/4 of NE 1/4, Section 2S, Town of te C'r-E- n t`L' Id OR <br />Lot(s) , Block , Plat of JJ j <br />✓ No CCSM , 6, 01 / L DT `1 <br />Additional information (optional): �n Aket'lik.&.4 <br />Name(s) of previous owner(s) (if known): <br />Co ents: 3 / 2 — Sb / P6C9-t27 %` / / 3 <br />11)632 Z3, R3tros -2 <br />Sketch map provided? Yes <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 />