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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1),WIS.STATUES <br /> $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMrrI"rED-I B.C. $T Penalty Asses. <br /> THE UNDERSIGNED,BEING 15ULY SWORN AND UNDER t' $ Court Costs <br /> OATH,COMPLAINWOR AND ON BEHALF OETHE <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY J <br /> BELIEF,THAT ON OR ABOUT, $ TOTAL <br /> DAY OF WEEK I DATE VIOLATION I TIME ❑ AM I CONY TWP-VILLAGE-CITY <br /> PM e'-- :aft C 1 a" r_ <br /> NAME FAST FIRST --,LMI DATE OF BIRTH AGE <br /> L" MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX ❑ M <br /> ❑ F <br /> DID UNLAWFULLY <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION-STATE FACTS) <br /> in violation of section(s) of the ❑ Ordinance <br /> and prays that he/she may be held to answer therefore. ❑ Burnett Co.ordinance adopting sec. <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 20 Title <br /> Name Title Department or Agency ` <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> r F THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ f <br /> A.M. <br /> ON `" r 20 1 ' 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 />