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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date:OTc <br />Landowner information: <br />Name: " A <br />Address: t J2n .c, rk . City:( S Ptcuip,S Zip Code: 53S�L� <br />Daytime phone: 577 27 7 <br />Fax: <br />Receipt # <br />E-mail: <br />Applicant ;nfonnatti n (if different from landowner): <br />i <br />Name: (/�/I <br />Address: City: Zip Code: <br />Daytime phone: <br />Fax: <br />E-mail: <br />Relationship to landowner: <br />Are you subthitting this application as an authorized agent for the -landowner? Yes No <br />Property information (be as specific as possible): <br />Property address: <br />Tax Parcel ID 4: 0•70-7 - Ogg-Igoo g` 0767-c PL-9ggo-7 <br />Legal description of property: 0707— 06 3—il g it; 0707-0`i3-903o-7 <br />• 1/4 of 1/4, Section 0 7 Town of C/'dSS 12F/aAcctS .OR <br />Lot(s) , Block , Plat of <br />Sketch map.provided? Yes No <br />Additional information (optional): <br />Name(s) of previous owner(s) (if known): A4G-V-C" 4 /1- 6 vSh (070 7 - v 8 - <br />Comments: V-ei' )" d,,11iS (3 4 cr eat -nail) <br />L,� ��.af 07o7J o p -q90-7 I <br />��� ,�,rs1, 0+t(4) 4,5 tt,rat <br />ilizr NL (e-fs < at-\1/z_26LgMI- <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 />H:\Zoning\Zoning Division DocumentationWorm\parcel status appiication.doc Page 2 of 2 Revision 11.26.2007 <br />