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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1),WIS.STATUTES <br /> $ ' � 'Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 2740 $ }Penalty Assess. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY , <br /> BELIEF,THAT ON OR ABOUT, $ _TOTAL <br /> DAY OF WEEK DATEjV�OLATION TIME COUNTY j TW ILLAGE-CITY <br /> PM <br /> NAME `LAST FIRST MI DATE OF BIRTH AGE <br /> 'kv ry MO. DAY YR. <br /> STREET OAR ROUTE #_ �, ; CITY,STATE,ZIP CODE ^Y� � n SEX F <br /> ! F tJ <br /> DID UNLAWFULLY <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFEZANT(DESCRIBF VIOLATION-STATE FACTS) ,•� � ��`7/� <br /> r� s <br /> in violation of section(s) _,, ' ' ? , of the ❑ Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett Co.ordinance adopting sec.. ,r <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title <br /> Name Title Department or Agency 6r—„15 <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE -3v 1l ` <br /> ABOVE NAMED COURT ... �_lj <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ I <br /> M. <br /> ON r � 20 'AT ,r :'i ❑ 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 />