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i r` It Dane County Department of Planning & Development Application for Determination of Parcel Status Date: ► 0 - )4- Q 7 Landowner information: Name: PA47`,`c. A J &An y Address: $ S' v.s P S / Zip Code: S3 S �R Daytime phone: ro 042 — 8"77 9 Fax: E-mail: IC),) )oi/y a'i -Fo. G�S�"O ti.l ,'Sc . wk..) Applicant informs ion (if different from landowner-):L Name: ken p o"�. (Ada"v peS,'9h * CC�►+sr�L /'✓c.i )9n, Address: P 0 1 -7)- 7 City: M o,d i S o Zip Code: -S' 3' 7 0 7 Daytime phone: G o4s- ' q 009 Fax: E-mail: ken odo,Ms q-f' MAd i� n n Relationship to landowner: R v,')� Are you submitting this application as an authorized agent for the landowner? Yeses No_ Property information (be as specific as possible): Property address: `a.$'1 ✓5 fitl,woy S / Tax Parcel ID #: / / - 6 yy - qSQ / - / Legal description of property: S1✓ 1/4 of S 1/4, Section () &/ , Town of Qvkork OR Lot(s) , Block , Plat of Sketch map provided? Yes -X_ No Additional information (optional): Name(s) of previous owner(s) (if known): Comments: 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:\PlanDev\Zoning\ZLR\Forms, Applications & Informational Materials\Parcel status application.doc