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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />cotA <br />Date: G "/$-O <br />Landowner information: <br />Name: <br />Address: <br />Daytime phone: <br />Fax: <br />,Toe,I <br />Receipt # / 'o? <br />C OCift <br />City: V&A-0 n (L Zip Code: <br />5? 5; <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: <br />Relationship to landowner: <br />E-mail: <br />Are you submitting this application as an authorized agent for the landowner? Yes V No <br />etc VCc Pe <br />.CQrA <br />Property information (b as specific asspossib e): Rare p <br />Property address: 1 S �C'it`,S J �1 of yg � r It '( Rood <br />Qnn <br />Tax Parcel ID #: 4 `) ©� I l o� ^ �p ?o " 0 <br />Leg l description Qf property: I <br />N KJ 1/4 ofN W , 1/4, Section 19 , Town of V LI\ 0 Rd. OR <br />Lot(s) , Block , Plat of <br />Sketch map provided? Yes Y No <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): <br />Comments: <br />T�omaS 004 <br />14Ar , GL)f <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 />