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UNIFORM ORDINANCE CITATION <br /> BURNETT COUNTY SECTION 66.1190), WIS. STATUTES $ '?" Forfeiture <br /> STATE OF WISCONSIN DEPOSIT PERMITTED B.C. ' ' ° $ Penalty Assess. <br /> THE 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 $ TOTAL <br /> BELIEF,THAT ON OR ABOUT, <br /> DA OF WEEK DATE VIOLATION I TIME ❑ AM COUNTY TWP- ILLAGE-CITY <br /> NAME LAST ,� FIRST I DATE OF BIRTH AGE <br /> c MO. DAY YR. <br /> STREET OR ROUTE CITY,STATE,ZIP CODE SEX -B-M <br /> DID UNLAWFULLY <br /> ON THE ABOVE STATED TIME,DATE AND LOCATION THE DEFENDANT(DESCRIBE V LATION STATE FACTS) <br /> j1 of e- C Y-J,•�e.'r' <br /> (J(,(i":rtxt h eolSve,U `? .. �ry L/�lJi ' C/d t ti d l e"�t5Al�; <br /> in violation of section(s) �� `--r_4 of the ❑ ! Pt ' { C Ordinance <br /> and prays that he/she may be held to answer therefor. ❑ Burnett Cod ordinance kdopting sec. <br /> / ./ <br /> Signature of Officer <br /> SUBSCRIBED AND SWORN TO Before me this date 19 Title 's <br /> Name Title Department or Agency"— � <br /> YOU ARE HEREBY NOTIFIED TO APPEAR IN THE <br /> ABOVE NAMED COURT - 4t�) J„4111 <br /> � <br /> THE MAXIMUM FORFEITURE FOR THIS VIOLATION IS$ s — <br /> j <br /> ON 19t ATI ElPA.M. Y- <br /> .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 /> { <br />