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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. 3 2 3 $ Penalty Assess. <br /> THE UNDERSIGNED,BEING DULY SWORN AND UNDER ' --Z • O <br /> OATH,COMPLAINS FOR AND ON BEHALF OF THE $ Court Costs <br /> COUNTY OF BURNETT UPON INFORMATION AND CIRCUIT COURT OF BURNETT COUNTY J <br /> BELIEF,THAT ON OR ABOUT, $ ^� ' TOTAL <br /> DAY OF WEEK DATE VIOLATION TIME ❑ AM COUNTY _ TWP-VILLAGE-CITY <br /> u' 9 -U �M l�r�:���T J AC� x�'t✓ <br /> NAME LAST n FIRST MI DATE OF BIRTH AGE <br /> fL AC-4 1 MO. DAY YR. <br /> STREET_OR ROUTE CITY,STATE,ZIP CODE SEX -�M <br /> DID UNLAWFULLY ' 01.4e_ RCSf"r,�tG_ (ig .fr` <br /> ON TEIEj VE STAT%IME,DATE AND LOCATION,THE DEFENDANT(QESCRIBE VIOLATION—STATE FACT ) f ` <br /> 1`}Ic K 7 /�' �z.c/rn� �Y•Get `h �rP r+i-e ylee'-; jj-' � [c} p r f <br /> f/r + �'.CA � #` +{(t�-G�/�se/t <br /> AC4 �+ f�`�/�.:fs�W� }�1� S^• J—��" �4�.ft �?L! i "�C'C,'�! iGtE- "��;tF�t,� <br /> f�� f f f J <br /> in violation of section(s) ,mil �� of the ❑ ° l � Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett..Cq.ordinance adopting sec. <br /> Signature of <br /> Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Tide <br /> Y <br /> Name Title Department or AgencyA <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT <br /> > THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ —� <br /> � � �LJ 1t'.� A.M. <br /> ON 19_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 />