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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1),WIS.STATUES $ 1 Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED 0 $ Penalty Asses. <br /> B.C. y <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE 1 <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 ❑ AM COUNTY TWP-VILLAGE-CITY <br /> PM <br /> NAME LAST FIRST �l DATE OF BIRTH AGE <br /> i MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX C NI <br /> C F <br /> DID UNLAWFULLY y. ` <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION-STATE FACTS) <br /> in violation of section(s) of the ❑ Ordinance <br /> and prays that he/she may be held to answer therefore. ❑ Burnett Co.ordinance adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title " <br /> Name Title Department or Agency <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> .• � F THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> 13 A.M. <br /> ON "` 20'— 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 /> UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1) WIS.STATUES <br /> � $ <`° Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. $ Penalty Asses. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER $ 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 FTWP- <br /> ILLAGE-CITY <br /> •g Y. [J PM r <br /> NAME LAST FIRST MI DATE OF BIRTH AGE <br /> - - MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX ❑ M <br /> , ❑ F <br /> DID UNLAWFULLY <br /> ON TJ-IE ABOVE STATED TIME,DATE AND LOCATION THE DEFENDANT(D S I IOLATION-STATE S) <br /> in violation of section(s) of ❑ ' Ordinance <br /> and prays that he/she may be held to answer therefore. Burnett Co.ordinance adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title <br /> Name Title Department or Agency <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COU T <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> A y'3.A.' - M. <br />