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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES S UC— Forfeiture <br /> il - <br /> STATE OF WISCONSIN DEPOSIT`PERMITTED B.C. 1168 5.:,1-s) Penalty Assess. <br /> t � u <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER S Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY S✓ G TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK DATE VIOLATION I TIME ElAM COUNTY r, VIL AGE-CITY - <br /> OIL, PM fU�� N/U/V <br /> e <br /> NAME LAST �..�— FIRST MI DATE OF BIRTH AGE <br /> MO: DAY YR. <br /> STREET OR ROUTE T� 7- <br /> CITY,STATE.ZIP CODE SEX M <br /> SQ U tiu/+cls 1/ret./ /Yi 551/a ❑ F <br /> DID UNLAWFULLY � r h w e f f T-1`T-1` Cover. <br /> MGu2 CXGPS A1lA.I/l. ' <br /> t U U LYC.It t <br /> ON TBE ABOVE STATED TIM DATE AND L?ATIOrN�,THE DEFENDANT(DESC)R/I,BE VIOLATION—STAT A <br /> l//L/S� �•' T�Cdl3 A`J lL� 'H^�� '"`r ��r4Kyc, � �' <br /> let. <br /> / j <br /> C.' ILG`.✓'S. ,gt �( !r�(c G/;�C''F_,, fl a.. -P �L� /Cit {.✓.c_. 3'! <br /> in violation of section(s) <br /> of the 11` /A't'e t 1 06'' ! ` e n l� Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett Co.ordinance adopting Sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Title <br /> Name Title Department or Agency <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> �-J� / A.M. <br /> ON O U fT 191!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 />