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Dane County Department of Planning & Developme <br />Application for Determination of Parcel Status II�r��:,D <br />MAR - 4 2009 <br />Date: _5 3 - 0 9 <br />Landowner information: /� <br />Name: Frec\er;ck -t- Vir9,4;c.. Beufii;n <br />Address: 10 I 9 1i) 4+ s cn - City: Mg zo ynq Zip Code: 63 5( 0 <br />Daytime phone: 0 k- 7 9 5- 00 6 0 <br />Fax: E-mail: Fred V;rv; a:a 075ma:).r.(9,41 <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: <br />DANE,CO NTY PLANNING D PMENT <br />Receiptitt(0 <br />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 possible): <br />Property address: 101 a. 9/ u -F h e w^ So V Rd . i11 ci z. r rr\ a n i P I L OI 5 3 5/ 0 <br />S+uC y a 11 Pnrdels. <br />Tax Parcel ID #: g - 03 3-9 03 0-9 0306 - 101- 9000- a, <br />©5fo6 - 10 b.SO()- S 0 '06- t03-Y000-� , OBO(o-/o.2-98yv-S <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 informat:on (optional): <br />Name(s) of previous 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 />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 Revision 11.26.2007 <br />