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RECEIVED Dane County Department of Planning & Develo nt �.� �II'�IR 3 2009 Application for Determination of Parcel Status Date: ,7l4X d2 )-6 5 DAME COUNTY PLANNING & DEVELOPMENT Receipt # Landowner information: Name: �ci.a64 Address: 3 j s9 . Sc/A) e, d'r Or. City: 5 cr,A7ze,✓ Zip Code: S3..5- i Daytime phone: 60 8. a 77- ?9X Fax: E-mail: ,04p4 4)wee ),6166 c Applicant information (if different from landowner): Name: /mo o", 4 r,/ of? o,11 fc� - C)6/0 - S6 & i y 'e / Address: 3 9y1-7, ,e;ele City: S'ufd Zip Code: .S".zF/ Daytime phone: 6.G r?.. y38 —.S7 7 7 Fax: S66 , 778— 6 7 '/ E-mail: /#0,-„,$ � Coa� Sr��s Co ,'Or Relationship to landowner: ,ee4 / f - 7f f e�-- Are you submitting this application as an authorized'agent for the landowner? Yes JNo Property information (be as specific as possible): Property address: 3 , fc4 f ,Q Tax Parcel ID #: 06 /D - a 7.2 — 85 7Q - Legal description of property: 1/4 of 1/4, Section , Town of OR Lot(s) , Block , Plat of Sketch map provided? Yes No Additional information (optional): Name(s) of previous owner(s) (if known): Comments: $ /¢4. c4/ A d3 / lit e/^ /7`4!1/rr.Se t1 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