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<br /> . AP!'LICnTIOId FOR V7�R2111dC�.' ' � .
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<br /> ' � )�PFELLANT�»�n c N�/P' �J7r,��✓�of✓ ADllRESS �ti,il E��O 7T (llAc� .
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<br /> � � xrGhL D�SCRTPTZOI; OP PROPERTY IN �IU�STION (Tncluding T.ddre�s if '
<br /> Applicable} : ��„�S�a D� w- /s %P .� , > /�/r� u ' •
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<br /> . �1.cr ��r-✓ �in �o Tfi � 1o�A7' 7�'iiP�� n� Re!'aRd d � tl r�dfi� nr �
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<br /> /,[1H5� :�Io�an/ .
<br /> . (CHECI: OidLJ Oa,�ner in fee simple � X . Contraci• Purchaser
<br /> ' . Uate of present otonership of prope�ty ;ii oztimcr) �,,,�^19�� - '
<br /> - .Ae you the ot•mer of or purc?�asing a portion of a forr.!erly largcr �
<br /> re�orded lot or tract �ahich included the lot or truct in question?
<br /> � /�12/PR � ' � . , .
<br /> • Description of prior lot or tract: _sn� �,,�A�,o ' . .
<br /> . �QtL�'� �l� 99. �'q �.�) i o . �'i)i� I /�R�'.� s . � .
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