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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />7839, <br />`4'cOsS <br />Date: eilr4 <br />Receipt # NOVI <br />Landowner information: <br />Name: v G i-L S TA D <br />Address: / ' C ry L Ldettic" City: Ci="(' .S le iq /.c.,,s Zip Code: s 35E `i <br />Daytime phone:°' 6' C Y a C,2-- 1 t- 5'` (11) 6 e ? - -- <br />E-mail: e t/ ' s -t :Cr c l c' c.( s . / <br />Fax: <br />Applicant information (if different from landowner): <br />Name: <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: 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: f l l (o / t G (46{, <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 E ITV <br />ED <br />Sketch map provided? Yes ✓ No <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): <br />Comments: <br />S E P 4 2009 <br />DANE CCJId(Y KA il+lh i & DEVELOPMENT <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 />