HomeMy WebLinkAboutIncident #87H0202CITY OF OSHKOSH, WISCONSIN DEPOSIT ASSESS COURT-
COSTS" - TOTAL
UNIFORM MUNICIPAL CITATION & COMPLAINT S~`..' ; S } ~,~ ~
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STATE OF WISCONSIN CIRCUIT COURT BRANCH ~ '~~_ja. If °., ~~r j COUNTY OF WINNEBAGO INCIDENT NO - t' ~ ~~
THE UNDERSIGNED, AN OFFICER OR AND IN BEHALF OF THE CITY OF OSHKOSH BEING DULY SWORN, STATES UPON INFORMATION AND BELIEF THAT
THE SAID DEFENDANT DID, ON ~~ '` y ~'~ AT ~! 'HOURS, VIOLATE ORD. NO.
CITY TO WIT:
OF NAME - LAST, FIRST, MIDDLE INITIAL Describe Violation
OSHKOSH vs.
,
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ADDRESS IRE$~ENCEI :APT. NO. POST OFFICE/STATE ZIP
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PARENT OR GUARDIAN NAME, ADDRESS. PHONE
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PHONE AGE BIRTHDATE PLACE OF BIRTH
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M F WHT. BLK. NAT. ASN. HSP. NON EVES HAIR WEIGHT HEIGHT
AM. HSP
^ 1 . ~ ~ 2. C~ 3. C_~ 4. ~-' 1 . ^ 2. ^ ON HWY./STREET - PRIVATEIPUBLIC PROPERTY
DRIVER'S LICENSE STATE EXP. SOCIAL SECURITY NO.
AT
VEH.-PLATE EXP.
4 STATE
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t MAKE
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~t YEAR MODEL COLON
COUNTY WINNEBAGO CITY
OF Of OSHKOSH
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YOU ARE HEREBY NOTIFIED TO APPEAR IN THE ABOVE NAMED COURT OFFICER'S SIGNATURE NUMBER
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a.M. "
AT
ON 19
R~M' SWORN TO BEFORE ME DATE:
LOCATED AT PUBLIC SAFETY BUILDING - i,, 420 JACKSON ST. OSHKOSH
WI 54901 TITLE
,
AGENCY COPY
ARREST
NO.
AGENCY RECORD
DATE OF DISPOSITION STIPULATION ASSESSMENT COURT TOTAL
- ~ COSTS
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With raw by A ncy Reason
Denied by Prosecution Reason
Dismissed -Reason
PLEA:
' GUILTY NOT GUILTY ;~~QCONTEST
FINDINGS:
NOT GUILTY _ UILTY
SENTENCE:
C~ S +COSTS AND/OR
~ DAYS JAIL AND/OR
DAYS IN JAIL FOR FAILURE TO PAY:
INCIDENT REPORT:
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