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UNIFORM ORDINANCE CITATION <br />BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES $ Forfeiture <br />STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 'j �{1 8 $ Penalty Assess. <br />THE UNDERSIGNED, BEING DULY SWORN AND UNDER t $ Court Costs <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, $ TOTAL <br />DAY OF WEEK I DATE VIOLATION TIME EDAM COUNTY TWP-VILLAGE-CITY <br />❑ PM TT ii ' '1-1 <br />NAME LAST FIRST _,�jl DATE OF BIRTH AGE <br />Mb. DAY YR. <br />STREET OR ROUTE CITY, STATE, ZIP CODE SEXJ M <br />❑ F <br />DID UNLAWFULLY�- <br />ON THE ABOVE STATED TIME, DATE AND LOCATION, THE DEFENDANT (DESCRIBE VIOLATION — STATE FACTS) <br />- <br />in violation of section(s) <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 `'" j 19= AT ❑ P.M. <br />BURNETT COUNTY GOVERNMENT CENTER <br />of the ❑ <br />El <br />19 <br />Ordinance <br />Burnett Co. ordinance adopting sec. <br />Signature of Officer <br />Title <br />Department or Agency' <br />l.; <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS S -' <br />THE COURT MAY ALSO REVOKE ALL LICENSES, CONFISCATE ALL EVIDENCE AND <br />REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />