HomeMy WebLinkAboutIncident #90H0634 - #90H0635 (10/04/1990)CITY OF OSHKOSH, WISCONSIN
DEPOSIT
ASSESS
COURT-
TOTAL
UNIFORM MUNICIPAL CITATION S COMPLAINT
S
$
COSTS
$
$
7 / v
STATE OF WISCONSIN CIRCUIT COURT BRANCH__ COUNTY OF WINNEBAGO INCIDENT NO.
THE UNDERSIGNED, AN OFFICER FOR AND IN BEHALF OF THE CITY OF OSHKOSH BEING DULY SWORN, STATES UPON INFORMATION AND BELIEF THAT
THE SAID DEFENDANT DID, ON AT HOURS, VIOLATE ORD. NO.
CITY TO WIT:
OF NAME — LAST, FIRST, MIDDLE INITIAL Describe Violation
OSHKOSH vs.
ADDRESS IRESIDENCEI APT.. NO, POST OFFICEISTATE ZIP
PARENT OR GUARDIAN NAME. ADDRESS, PHONE
PHONE
AGE BIRTHDATE
PLACE OF BIRTH
M F
WET- BLK. NAT. ASN. LISP. NON
EYES
HAIR
WEIGHT
HEIGHT
AM. HSP
❑ ❑
1.(j 2. ❑ 3. F] 4.11 1. C] 22[}'
ON HWY.ISTREET - PRIVATE /PUBLIC PROPERTY
DRIVER'S LICENSE STATE EXP. SOCIAL SECURITY NO.
I
AT
VEH. - PLATE EXP. STATE MAKE YEAR MODEL COLOR
COUNTY CITY
I I I
WINNEBAGO
OF OF OSHKOSH
YOU ARE HEREBY NOTIFIED TO APPEAR IN THE ABOVE NAMED COURT
OFFICER'S. SIGNATURE NUMBER
ON 19 AT A.M.
SWORN TO BEFORE ME DATE:
TITLE
P.M.
LOCATED AT PUBLIC SAFETY BUILDING 420 JACKSON ST. OSHKOSH, WI 64901
AGENCY COPY
ARREST
NO.
AGENCY RECORD
DATE OF DISPOSITION STIPULATION ASSESSMENT COURT TOTAL
f ,Y— d/ 5.v- 1 CO5
Withdrawn by Agency - Reas rt- ti
Denied by Prosecution - Reas n
k'Dismissed - Reason `(j 6t
PLEA:
F GUILTY NO GUILTY n NO CONTEST
FINDINGS:
❑ NOT GUILTY ❑ GUILTY
SENTENCE:
❑ $ +COSTS AND /OR
❑ DAYS JAIL AND /OR
❑ DAYS IN JAIL FOR FAILURE TO PAY:
INCIDENT REPORT:
A FINAL inspect by the Housing In-
Spector revealed that the unapproved
material which had been installed in
the building waste system had not been
replaced,
SIGNATUR OF OFFICER DATE AND TIME OF INCIDENT REPORT
J, 1 10'4/90 1 0o
S YR
CITY OF OSHKOSH, WISCONSIN DEPOSIT ASSESS COURT-
COST
TOTAL
t'
UNIFORM MUNICIPAL CITATION & COMPLAINT S $ $
5
J r
STATE OF WISCONSIN CIRCUIT COURT BRANCH- . _ _ _ _ COUNTY OF WINNEBAGO INCIDENT NO
THE UNDERSIGNED, AN OFFICER FOR AND IN BEHALF OF THE CITY OF OSHKOSH BEING DULY
SWORN, STATES UPON INFORMATION
AND BELIEF THAT
THE SAID DEFENDANT DID, ON AT
HOURS, VIOLATE ORD -. NO.
TO WIT:
CITY
OF NAME — LAST, FIRST, MIDDLE INITIAL Describe
Violation
OSHKOSH vs.
ADDRESS (RFSIDENCEI APT. NO. POST OFFICElSTATE ZIP
PARENT OR GUARDIAN NAME. ADDRESS, PHONE
PHONE
BIRTHDATE PLACE OF BIRTH
M F
LJ ❑
NAT. ASN, HSP. NON
EWHTBLK.
AM- HSP
3. ❑ 4- ❑ 1. ❑ 2.1.E
EYES
HAIR
WEIGHT HEIGHT
ON HWY.ISTREET - PRIVATHPUBLIC
PROPERTY
DRIVER'S LICENSE STATE EXP.
SOCIAL SECURITY NO.
AT
VEH. - PLATE E11P
I STATE
MAKE
YEAR
MODEL
COLOR
COUNTY WINNEBAGO
OF
CITY
OF OSHKOSH
OFFICER'S SIGNATURE
NUMBER
YOU ARE HEREBY NOTIFIED TO APPEAR IN THE ABOVE NAMED COURT
AM.
ON 19 AT P.M.
SWORN TO BEFORE ME DATE:
TITLE
LOCATED AT PUBLIC SAFETY BUILDING 420 JACKSON ST, OSHKOSH, WI 54901
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