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Dane County Department of Planning & Development <br />Application for Determination of Parcel Status <br />Date: 6%5/20©£ Receipt # <br />Landowner information: / <br />be on*, 5 c( PA 1/ /45 /11S [ ( <br />Address: /5/2 iii-y 9z City: Oa--e Zip Code: v35i'3 <br />Daytime phone: (woe- S?S-©€ ?S <br />Fax: E-mail: <br />Name: <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: 44.-1 y q 2 <br />Tax Parcel ID #: ©yg/pro ? - 022 - -? 5/ — <br />Legal description of property: <br />0. 1/4 of/Yw 1/4, Section25'7, Town of /I i.,-, rose OR <br />Lot(s) , Block , Plat of <br />Sketch map provided? Yes X No <br />Additional information (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 <br />Revision 11.26.2007 <br />