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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1),WIS.STATUES $ Jtk.' Forfeiture <br /> . STATE OF WISCONSIN DEPOSIT PERM ED4 B.C. 2127 $ /�3i#r Penalty Asses. <br /> TIDE UNDERSIGNED,BEING DULY SWORN AND UNDER of ; 6`" ° $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY ¢)/", trci <br /> BELIEF,THAT ON OR ABOUT, $ .)' TOTAL <br /> DAY OF WEEK DATE VIOLATION/ TIME AM COUNTY �-LLAGE-CITY <br /> `' '` ./3 ❑ PM .�4— i; r <br /> NAME LAST FIRST MI DATE OF BIRTH AGE <br /> k p_eb,4 f 1 MO. DAY YR. <br /> STREET OR ROUTE CITI'.STATE.71P CODE SEX ] M <br /> r2 rt <br /> a�+ : _ ❑ F <br /> DID UNLAWFULLY; • " <br /> ON THE ABOVE STATED TIME.DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION-STATE FACTS) ! _ <br /> in violation of section(s) a of the 0 - Ordinance <br /> and prays that he/she may be held to answer therefore. 0 Burnett Co.ordfilitnce adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title J='J.' J f'e I.s►I <br /> Title r'-r /J L J' ,a✓" <br /> Name Department or Agency <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> i - c.. <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ ' , M <br /> �,_ ,,. .,,. , ,f,, . A.M. <br /> ON '~'° 20— ATE_'' 0 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 /> d <br />