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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.1190), WIS. STATUTES <br /> ` $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. $ 1 Penalty Assess. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER - rf, 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 DATE VIOLATION TIME ❑AM COUNTY _4 TWP-VILLAGE-CITY <br /> NAME LAST __�FIRST MI DATE OF BIRTH AGE <br /> it MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX U M <br /> } n, aC.r �F3 <br /> , <br /> DID UNLAWFULLY id `4 e t�z.) ;rt. {ice j .;. '," fy/ <br /> ON THE ABOVE STATED TIME DATE ANkLLOCATION THE DEFENDANT(DESCRIBE VIOLATION STATE FACTS) <br /> e <br /> t- ; '_ _�. �t F-r*�.': r€ .3 e'r't�"'�:`� --z•=.. � 5 r _ '?"f�'+G - } 1 - �, €� ar'i 3 <br /> r` r <br /> in violation of section(s) of the <br /> t f <br /> ❑, 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 /> r THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> A.M. <br /> ON �i— t9,—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 />