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UNIFORM ORDINANCE. CITATION <br /> LURNETT COUNTY SECTION 66.1190), WIS. STATUTES $ .% Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. $ d t' 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 $ �! `� 'TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DAY OF WEEK I DATE VIOLATION I TIME ElAM COUNTY TWP-VILLAGE-CITY <br /> f - 0 PM <br /> NAME j LAST FIRST MI DATE OF BIRTH AGE <br /> 1 pi, 42, , MO. DAY YR. <br /> STREET OR-ROUTE CITY STATE,ZIP CODE SEX ❑ F <br /> t_` <br /> DID UNLAWFULLY r t.•.,..(r` ABC Cv <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FACTS) <br /> in violation of section(s) �� •} of the ❑ A 0 Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ 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 J <br /> A.M. THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> ON 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 />