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UNIFORM ORDINANCE CITATION <br /> BIT COUNTY SECTION 66.1190), WIS. STATUTES r`�/��� �� <br /> $_ -L' Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 1306 $�i �—� Penalty Assess. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER <br /> 1 $ ! Court Costs <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 TWP-V[LLAGE-CITY <br /> i J" ❑ PM <br /> NAME LAST FIRST MI DATE OF BIRTH AGE <br /> 5 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) <br /> CJv r@G/C i�Ll/Niet/fit s I / tleA�,- <br /> Jam,e -� JI <br /> P' lM <br /> in violation of section(s) �l of the ❑ ' `�? — Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett Co.ordinanc r e adopting sec. <br /> , <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Title <br /> Name <br /> Title Department or Agency l R <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> t XA.M. THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> ON ff� 19"—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 />