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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.1190), WIS. STATUTES $ Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED a d <br /> B.C. � i,.; ( � $ _ Penalty Assess. <br /> T14E 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 }r "5 <br /> BELIEF,THAT ON OR ABOUT, $ "� o TOTAL <br /> DAY OF WEEK DATE VIOLATION I TIME ❑ AM I COUN TWP-VILLAGE-CITY .` <br /> Q PM <br /> NAME LAST FIRST MI DATE OF BIRTH AGE <br /> rs eo u 7t J I MO. DAY YR. <br /> STREET OR ROUTE _ CITY,STATE,ZIP CODE SEX <br /> rr�� �� tt ', ❑ M <br /> '?[J ��C1MNtl r S 11 WG' J y ❑ F <br /> DID UNLAWFULLY <br /> O .TH_E ABOVE STATED TIME,DATE AND LOCATION,THE DEFENDANT(DESCRIBE VIOLATION—STATE FACTS) <br /> a <br /> i <br /> X 5,` 35 1 t - <br /> C i ®'elc,l A 4�-:( <br /> //" E' u S <br /> in violation of section(s) of the'E7 ��A`• ' <br /> 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 Titled/ " <br /> Name Title Department or Agency 'rtr' <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT ��3. � <br /> / A M THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS <br /> ON =� 'r // 19 A R� ❑ 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 />