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UNIFORM ORDINANCE CITATION <br />BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES $ IQ� Forfeiture <br />STATE OF WISCONSIN DEPOSIT PERMITTED B.C. r $ 0 10 Penalty Assess. <br />THE UNDERSIGNED, BEING DULY SWORN AND UNDER L $ Court Costs <br />OATH, COMPLAINS FOR AND ON BEHALF OF THE <br />COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY J a� <br />BELIEF, THAT ON OR ABOUT, $ , TOTAL <br />DAY OF WEEK DATE VIOLATION TIME ❑ AM COUNTY TTIWP-VILLAGE-CITY <br />! ) ©'PM /-- a. <br />NAME LAST �_ FIRST MI DATE OF BIRTH AGE <br />MO. DAY YR. <br />STREET OR ROUTE CITY, STATE, ZIP CODE SEX 0 M <br />❑ F <br />DID UNLAWFULLY <br />ON THE ABOVE STATED TIME, DATE AND LOCATION, THE DEFENDANT (DESCRIBE VIOLATION — STATE FACTS) <br />i <br />in violation of section(s) of the ❑ <br />and prays that he/she may be held to answer therefor. ❑ <br />SUBSCRIBED AND SWORN TO Before me this date <br />Name Title — <br />YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br />ABOVE NAMED COURT <br />A. M. <br />ON 19 _ AT — ❑ P.M. <br />BURNETT COUNTY GOVERNMENT CENTER <br />Ordinance <br />Burnett Co. ordinance <br />Signature of Officer 3 <br />Title <br />Department or Agency <br />opting sec. <br />.c <br />rY� <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS $3 <br />THE COURT MAY ALSO REVOKE ALL LICENSES, CONFISCATE ALL EVIDENCE AND <br />REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />