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UNIFORM ORDINANCE CITATION <br />BURNETT COUNTY SECTION 66.119(1), WIS. STATUTES $ Forfeiture <br />STATE OF WISCONSIN DEPOSIT PERMITTED B.C. 1247 $ Penalty Assess. <br />THE UNDERSIGNED, LSING DULY SWORN AND UNDER fir. $ Court Costs <br />OATH, COMPLAINS FOR AND ON BEHALF OF THE <br />COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY <br />BELIEF, THAT ON OR ABOUT, $ TOTAL <br />DAY OF WEEK DATE VIOLATION I TIME 13 AM I COUNTY T)VP-VILLAGE-CITY <br />'r ❑ PM �% 5 - <br />NAME , LAST FIRST�rlvjl DATE OF BIRTH AGE <br />L N e MO.')DAY YR. <br />STREET OR R UTE CITY, STATE, ZIP CODE SEX ❑ M <br />Al. ' G" ❑ F <br />DID UNLAWFULLY�it, // i1,y1V'-4c SAI : �')r -c; -.! t <br />ON THE ABOVE STATED TIME, DATE AND ATION, THE DEFENDANT (DESCRIBE VIOLATION — STATE FACTS) <br />S r C i 4't t f'rf d1 r <br />�LL j <br />V , �.7• ,n fL e IAIA j 4,P r c Cl/Gin i1 uw G cf <br />( osf �creS , Mr ;--Pa `"rici- eu/l eG�-/!-G2, i4r.�( lrn�ff � l /fie /i <br />�i�jc"a <br />r✓ * e t L - ,n b t c. Or l'e4, <br />in violation of section(s) c - of the C 131 f AC' f � 61) SAAAt All' 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 a::i- <br />Name Title Department or Agency <br />YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br />ABOVE NAMED COURT �., , A <br />THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS $ 1 <br />9 <br />ITU 2- /1 A.M. <br />ON (A C.-1.9--- AT� ❑ P.M. THE COURT MAY ALSO REVOKE ALL LICENSES, CONFISCATE ALL EVIDENCE AND <br />BURNET COUNTY GOVERNMENT CENTER REQUIRE RESTORATION OR RESTITUTION OF ANY ENVIRONMENTAL DAMAGE. <br />