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.t Dane County Department of Planning & Development Application for Determination of Parcel Status Date: ii-i-o9 Receipt # Landowner information: Name: 54even A Lc) Ans v- DoAms Address: 117o Us N,bAway /y City: 0Rf6on Zip Code: 9-3575- Daytime phone: too? - S 3 T- ci y y Fax: E-mail: wrLLYS lact2Es c msn .C.om Applicant information (if different from landowner): Name: Address: City: Zip Code: Daytime phone: Fax: E-mail: Relationship to landowner: Are you submitting this application as an authorized agent for the landowner? Yes No Property information (be as specific as possible): Property address: /17o us /4)shuDccy lei , b)Frron , w 5-3575- Tax Parcel ID #: o5 iv -o�� -$gSC� 'F� o7 ip -oi.- 5-0-9 , olio- 079 - -000 - Legal description of property: 1/4 of 1/4, Section , Town of TS w4-16. d OR Pa2-+ o fi — F va. o 4- Se kj--ti 6y, -7, fi '5 n , R / o a Tow n Lot(s) , Block , Plat of 1Z/es C-12k P- , . e r A- 7- 16-` l\ Sketch map provided? Yes No Additional information (optional): Name(s) of previous owner(s) (if known): 0. tth'ecl.. Pia.1 .E ve7ti n-e\ADberry ' - /anal , aerie C-0 Comments: I p C(.�o e d r . a. ea `YA-a .�wta re ois o cJi� �%e cue —ha c444 f 4 Vu *cte r-10 Important Notice: A Dane County parcel status determination is preliminary in nature and only determines if a parcel of land was created in accordance with Dane County ordinance provisions. Additional title history research conducted by a title company may be necessary to verify parcel status. Dane County and its staff are not responsible for any misrepresentation or mischaracterization of the information contained in the parcel status determination. Please allow 3-6 weeks to process your request. A copy of the report will be mailed to the landowner, the applicant (if different from the landowner) and the town clerk. S:\Web_Transfers\PlanDev\Parcel status application.doc Page 2 of 2 Revision 11.26.2007