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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES <br /> $ !` Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 115� $ -t.� penalty Assess. <br /> v , . <br /> `-THE UNDERSIGNED,BEING DULY SWORN AND UNDER f $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE <br /> COUNTY OI'BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY ' <br /> BELIEF,THAT ON OR ABOUT, $''" TOTAL <br /> DAY OF,WEEK I DATE VIOLATION TIME ❑ AM COUNTY TWP-VILLAGE-CITY <br /> J ,' ❑ PM <br /> NAME LAST _� FIRST MI DATE OF BIRTH AGE <br /> Af y` it I C-)\0 I MO. DAY YR. <br /> STREET OR ROUTE .1 CITY,STATE,ZIP CODE SEX M <br /> El F <br /> DID UNLAWFULLY <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FACTS) / <br /> G N /l E+r NtJUA �P lts— S 0"" h tJ' <br /> f i S tf?,A,k— &f Mt K.P 14 t.t i u i, . ._e 1, €' <br /> i , t r <br /> I <br /> s <br /> j in violation of section(s) of the El Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ 2 13't Burnett Co.ordinance ado ting sec. <br /> k `Signature of Officer .. <br /> ! _ -/,-, C4 <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Title <br /> ( ry j�pt r . <br /> i Name Title Department or Agency r�� + 1//� <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ <br /> ON `"� �� A.M.19—AT/d ❑ 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 />