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06/13/2008 11:30 608-267-1540 <br />DANE CO PLANNING <br />PAGE 02/ 02 <br />• <br />Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: 611 Job Receipt # <br />Landowner information: <br />Name: <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: E-mail: <br />Applicant information (if different from landowner): 1 <br />Name: /' ,-aa.-� Zt Inkmc�� Gizou►e (�1►e-��-rr�p-� u- NA,S4 <br />Address: "2 Sc� U1n-10 -r City: Zip Code: 535+1 <br />Daytime phone: (av 9a8— Seely <br />Fax: Clio) 4,14 24:434 E-mail: e./ S4 P•SL -L AA e . Co-gt4 <br />Relationship to landowner: <br />Arc you submitting this application as an authorized agent for the landowner? Yes x No <br />Property information (be as specific as possible): <br />Property address: 2 T tJ. b1.44 )"n - <br />Tax Parcel ID #: <br />Legal description of property: <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) ofprevious owner(s) (if known): <br />Comments: _ <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 />luwfscfiaracterikaffon oft'fte n,itn auJGv►r crrtrentiter?ifr s a - <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:1Web_Transfers\PlanDevtParcel status application.doc Page 2 of 2 Revision 11.26.2007 <br />