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r A i <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: <br />Receipt # /29-a, <br />Landowner information: <br />Name: air'9 <br />'d Zip Code: <br />Address: (Y <br />1,e el <br />Daytime phone: <br />Fax: (C6gJ i <br />E-mail: J 1,rr_5 ree ].A, nq iksh aS - Ne° <br />Applicant information (if different from landowner): <br />Name: `. \,,rV. /94 eJ <br />Address: V4 H,h„ City: Cad : ;d� Zip Code: -c`- a3 <br />Daytime phon6: 66gj 4q-'3G <br />Fax: Z,0— E-mail: `.S: r.,5 rye; I.�' e 1, f2a2 h - , ;,Ge <br />Relationship to landowner: r.J/7p!' / Frirnd <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: <br />Tax Parcel ID #: c-9/-��- <br />Legal description of property: <br />•5 t 1/4 of 1'I) i 1/4, Section .3/4. , Town of -/Di,G, /d .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: ��„�� J ,pv/4 �,rl� >. > - _// 2r"e-/ a-S <br />r� `.t I g_ U_5 r ,.nr S/ /e i S <br />imtTn.,S ( c-f 7/9 P/foci p/a,r„ a !ea - <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:\Web Transfers\PlanDev\Parcel status application.doc Page 2 of 2 <br />Revision 11.26.2007 <br />