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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.1190), WIS. STATUTES $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. $ Penalty Assess. <br /> _., <br /> 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 $ 3 TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK DATE VIOLATION TIMEE M COU TY TWFNI AGE-CITY <br /> M U/NG <br /> NAME LAST FtIRSTML DATE OF BIRTH AGE <br /> !1 jyy Mo. DAY YR. <br /> STREET OR ROUTE ` , CITY,STATE,,ZIP CODE {? SEX ❑ M <br /> ❑ F <br /> DID UNLAWFULLY t't' = � Ci �tS i�%++✓ �"' <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE D F�NDANT(DESCRIBE VIOLATION—STATE FACTS) <br /> s"E'e"' f -7 <br /> f.. ��.ra, �✓�/ <br /> f'/ j. <br /> in violation of section(s)�l of the❑944« f4 —'�rdinance 90* ?j ,y�o1 <br /> and prays that he/she may be held to answer therefor. El 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 /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> L A.M. <br /> ON �f"i 19 43 ATf 0 ❑ P.M. THE COURT MAY ALSO REVOKE ALL LICENSES, CONFISCATE ALL EVIDENCE AND <br /> BURNE* COUNTY GOVERNMENT CENTER REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />