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UNIFORM ORDINANCE. CITATION <br />BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES <br />$ Forfeiture <br />STATE OF WISCONSIN <br />DEPOSIT PERMITTED B.C. � Y <br />$ Penalty Assess. <br />THE UNDERSIGNED, BEING DULY SWORN AND UNDER <br />c � <br />/� <br />$ Court Costs <br />OATH, COMPLAINS FOR AND ON BEHALF OF THE <br />COUNTY OF BURNETT UPON INFORMATION AND <br />CIRCUIT COURT OF BURNETT COUNTY <br />BELIEF, THAT ON OR ABOUT, <br />$ TOTAL <br />DAY OF WEEK <br />DATE VIOLATION <br />TIME ❑ AM <br />COUNTY <br />qW-PiVILLAGE-CITY <br />- t <br />I ! q <br />PM <br />j 17 - <br />NAME LAST FIRST <br />MI <br />DATE OF BIRTH <br />AGE <br />MO. DAY YR. <br />STREET OR ROUTE <br />CITY, STATE, ZIP CODE <br />SEX M <br />J <br />r tAli s . d% <br />❑F <br />DID UNLAWFULLY ;s� `'r. + c A <br />t,J t ',vim <br />ON THE ABOVE STATED TIME, DATE AND L TION, TPE DEFENpANT (DE CRIBE VIOLATION — STATE FACTS) <br />�✓NSt.�/.. 3ftLtsnvLT1y.� L[rLG( C{. <br />. <br />.r Ec.ri �u� �Qe'ry �CiA.i�7'ai•�7`c:;� c3r+� <br />dQA, <br />ht «.,i +�3�"f'4� tSStfPt� <br />G`NT, c"T Gc•il f%1, /y��rti j " t/tenC <br />-r , <br />}' . !-f?I M �ti.�! �Ut� S7�/'�.T��.l ,Cj �'c l� ✓d/1?"�f t%�-� �i�!'','- ��L /C (,`° <br />�'—� <br />�ON/nom+ <br />in violation of section(s) <br />of the ❑ Ordinance <br />and prays that he/she may be held to answer therefor. <br />❑ Burnett Co. ordinance adopting sec. <br />Signature of Officer <br />SUBSCRIBED AND SWORN TO Before me this date <br />19 Title A,11- _ <br />Name Title <br />Department or Agency A <br />YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br />ABOVE NAMED COURT <br />4 , <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS $ <br />f <br />ON Yep r�r� 19 AT 16 ❑ P.M. <br />THE COURT MAY ALSO REVOKE ALL LICENSES, CONFISCATE ALL EVIDENCE AND <br />BURNETT COUNTY GOVERNMENT CENTER <br />REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />