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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.119(l), WIS. STATUTES <br /> $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMI TTD B.C. 1196 $ Penalty Assess. <br /> THE tiNDERSIGNED,BEING DULY SWORN AND UNDER -N $ Court Costs <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE <br /> COUNT'OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY <br /> BELIEF,THAT ON OR ABOUT, $ TOTAL <br /> 3 D jF�WEEK DATLVIOLATION I TIME ❑ AM C T TWP-VILLAGE-CITY <br /> Cal! ElPM � EDATE <br /> f NAME LAST�q FIRST MIF B►RTH AGE <br /> -1"'fVeA-., O. DAY YR. <br /> S BEET R RO Y,STATE,ZIP CODE lsl U SEX ❑ M <br /> f ❑ F <br /> DID UNLAWFULLY)5 /r UI'r, Ji , (Er7 tr r f k nor <br /> 0 T E A OVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FA ) <br /> .ter <br /> i <br /> tt t i t� <br /> in violation of section(s) • 7 <br /> of the ❑ Ordinance sr '.M C t,- A <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 Titlef <br /> Name Title - �! Department or Agency `` <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE C: <br /> ABOVE NAMED COURTA. <br /> // ❑ M THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ 3 Y <br /> ON f< 19_AT— ❑ P. THE COURT MAY ALSO REVOKE ALL LICENSES,CONFISCATE ALL EVIDENCE AND <br /> BURNETT COUNTY GOVERNMENT CENTER EQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />