Laserfiche WebLink
UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 23.54, WIS. STATUTES FORM 4100-70 REV.9-80 $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.c. NQ 104 $ !7•�� Penalty Assess. <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 $ �,��t1 TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK I DATE VIOLATION TIME ❑ AM COUNTY CODE TWP-VILLAGE-CITY CODE Q WHI ❑ BLK ❑ NAT.AM. <br /> El <br /> PM f ElASN ElHSP ElNON-HSP <br /> NAME LAST FIRST MI DATE OF BIRTH AGE EYES <br /> MO. DAY YR. HAIR <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX 0 M WGT. <br /> r ,? El F HGT. <br /> DID UNLAWFULLY <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FACTS) <br /> �r <br /> in violation of section(s) of the❑ Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett Co.ordinance adoptinr. <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 /> -��( THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> r7 Of-, >�i A.M. <br /> ON 19—AT ❑ P.M. THE COURT MAY ALSO REVOKE ALL LICENSES,CONFISCATE ALL EVIDENCE AND <br /> CITY REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />