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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1),WIS.STATUES $ 9-CO Forfeiture <br /> " STATE OF WISCONSIN DEPOSIT PERM,TTED B,C, M $ 1 ,✓""" Penalty Asses. <br /> TPfE UNDERSIGNED,BEING DULY SWORN AND UNDER '•"} £' ' ` ~ G Q $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE { , �1 <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> ,,,,,..DAY OF WEEK DATEVIOLATION TIME AM CO i a TWP-VILLAGE-CITY <br /> l/ f'17""/-7 El PM 'k1 <br /> NAME LAST ,FIRST MI DATE OF BIRTH AGE <br /> '� Li't�`j MO. DAY YR. <br /> STREET OR ROUTE �/ CITY.STATE.ZIP CODE SEX ❑ \I <br /> DID UNLAWFULLY kt if' .� r p', <br /> ON THFIBOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION-STATE FACTS) <br /> C (.., A. <br /> u 1 . <br /> ✓ r. # <br /> in violation of section(s) of the ❑ - Ordinance <br /> and prays that he/she may be held to answer therefore. ❑ Burnett Co.ordinance adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title.."''""'�' I r '.•s ic" 1 <br /> frri <br /> Name Title Department or Agency- ' <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE r <br /> ABOVE NAMED COURT THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ /. �'4 <br /> ON /�a .20� 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 /> —.-- r <br />