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UNIFORM ORDINANCE CITATION <br />BURNETT COUNTY SECTION 66.119(1), WIS. STATUES <br />STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 130 <br />THE'UNDERSIGNED, BEING DULY SWORN AND UNDER <br />. OATH, COMPLAINS FOR AND ON BEHALF OF THE <br />COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY <br />BELIEF, THAT ON OR ABOUT, <br />Y OF WEEK I DATE VIOLATION TIME ❑ AM COUNTY_ TWP-VILLAGE-CITY <br />U PM <br />NAME LAST FIRST MI DATE OF BIRTH AGE <br />MO. DAY YR. <br />STREET OR ROUT -fig CITY. STATE, ZIP CODE ro SEX `E] M <br />';' E .4 jrc!L lut C"�' F fr' w ��,iR,) ❑ F <br />DID UNLAWFULLY J,r,/ <br />ON TH%AB VE STATED TIME, DATE AND LOCATION, THE DEFENDANT (DESCRIBE VIOLATION - STATE FACTS) <br />+ 1 )Cs •+' IIS.. ! d�A, <br />p fe" c,, <br />in violation of section(s) of the ❑� �' `"tet{ Ordinance <br />and prays that he/she may be held to answer therefore. ❑ Burnett Co. prdinance adopting sec. <br />f <br />Signature of Officer T : <br />SUBSCRIBED AND SWORN TO Before me this date 20 Title <br />.R <br />Name Title Department or Agency—,L <br />YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br />ABOVE NAMED COURT / <br />� A.M. <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS $-3 ` } <br />ON 20 : AT ElP.M 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 />$3%' `-' <br />Forfeiture <br />$ <br />Penalty Asses. <br />$ <br />Court Costs <br />$ <br />TOTAL <br />ON TH%AB VE STATED TIME, DATE AND LOCATION, THE DEFENDANT (DESCRIBE VIOLATION - STATE FACTS) <br />+ 1 )Cs •+' IIS.. ! d�A, <br />p fe" c,, <br />in violation of section(s) of the ❑� �' `"tet{ Ordinance <br />and prays that he/she may be held to answer therefore. ❑ Burnett Co. prdinance adopting sec. <br />f <br />Signature of Officer T : <br />SUBSCRIBED AND SWORN TO Before me this date 20 Title <br />.R <br />Name Title Department or Agency—,L <br />YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br />ABOVE NAMED COURT / <br />� A.M. <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS $-3 ` } <br />ON 20 : AT ElP.M 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 />