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UNIFORM ORDINANCE CITATION <br /> BURNETT,COUNTY SECTION 66.1190), WIS. STATUTES $ Forfeiture <br /> DEPOSIT PERMITTED B C ; $ Penalty Assess. <br /> STATE OF WISCONSIN — $ Court Costs <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 $ TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK DATE VIOLATION TIME ❑ AM COUNTY %� �r TWP-VILLAGE-CITY <br /> PM <br /> NAME LAST <br /> ' FIRST. MI DATE OF BIRTH AGE <br /> t MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX ❑ M <br /> El F <br /> DID UNLAWFULLY' <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FACTS)Li <br /> in violation of section(s) <br /> 1 : of the ❑ Ordinance <br /> El Burnett Co.ordinance adopting sec. <br /> and prays that he/she may be held to answer therefor. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Title _* y <br /> Name <br /> Title Department or Agency f. <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> *)C.-0� /�(�j A.M. <br /> Z <br /> ON Y9'—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 />