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UNIFORM ORDINANCE CITATION , <br /> BURNETT.COUNTY SECTION 66.119(1),WIS.STATUES $ CO Forfeiture <br /> _` STATE OF WISCONSIN DEPOSIT PERMTITED B.C. 2689 $ _ Y _ Penalty Asses. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE , f <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY $ , 9! s TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK DATE VIOLATION TIME 0 AM COUNTY 0-VILLAGE-CITY <br /> ® PM t4 0 I/Ir- <br /> f <br /> NAME LAST FIRST MI ,-"_' DATE OF BIRTH AGE <br /> r`- MO. DAY YR. <br /> STREET OR ROUTEty, CITY,STATE,ZIP CODE,�,, A,,,l/?7 vs, SEX ❑ M <br /> El F <br /> DID UNLAWFULLY VI 4,7 >-.- <br /> - ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION-STATE FACTS) <br /> ( 'L> tI <br /> in violation of section(s) of the ❑ Ordinance <br /> and prays that he/she may be held to answer therefore. 0 Burnett Co.ordinance adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title <br /> Name Title Department or Agency "-- <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT f / =-' r <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ ''rtCAI <br /> ON 20 -_ Y AT_ ❑ P.M. THE COURT MAY ALSO REVOKE ALL LICENSES,CONFISCATE ALL EVIDENCE AND <br /> BURNETT COUNTY GOVERNMENT CENTER REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />