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i)Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: bin /cn <br />Landowyler information: <br />Name: .A 11'1SA'1V1F M. �\,r `r1 _ <br />Address: 18B I � °. I � City: rRe IA. Zip Code: � 3S. 1 <br />Daytime phone: <br />E-mail: mini vOder@ yahoo, Cony, <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: Zip Code: <br />Fax: <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 p oss^iwble : <br />Property address: JS 5 }�W\..I lat Ili ' 'r f Ic& LAIL �3S3 <br />Tax Parcel ID #: Li a1-1--ITY71 -ctz30R- <br />Legal description of property: ,j <br />1/4 of 1/4, Section , Town of OR <br />Lot(s) <br />, Block , Plat of <br />Sketch map provided? Yes No %< <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): <br />Comments: reblik10 a.-0-4tr <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 />