The following statutes affect this form: ss. 66.0113 (1) and 800.02 (2), Wis. stats. STATE OF WISCONSIN
Town of ________
________ County
Town of ________ Citation
Name of defendant: ____________________
Statement of corporate status [if applicable]*: ____________________
Defendant’s date of birth: ____________________
Defendant’s license number [if applicable]: ____________________
Description of violation: ____________________
Permit violated [if applicable]: ____________________
Time and location of violation: ____________________
Ordinance violated: [identify section violated and provide a brief explanation and nature of the violation]
Maximum forfeiture, plus costs, fees, and surcharges for violation alleged in this citation: $______________
Name and office of official issuing citation: ____________________, ____________________
[Signature of official issuing citation]
This matter will be before the [choose one: 1. municipal or 2. circuit] court of the __________ [choose one: 1. Town or 2. County] of ___________________ at the following date and time: ______________________. You are [select one: 1. required or 2. not required] to appear in that court at that time.
Amount of deposit: $__________.
Please read all of the following:
1. You may make a cash deposit of [insert amount] $__________ to ____________________ [specify official to whom the deposit must be made] no later than __________. If you have been arrested for the violation referenced above, you may make this deposit and obtain release from that arrest.
2. If you make this deposit, you do not need to appear in court unless appearance is required by the court or you are subsequently summoned.
3. Whether or not you make the deposit, you may, in writing, prior to the court appearance, enter a plea of not guilty.
4. If you make the cash deposit and do not appear in court at the time specified, one of the following will happen:
a. The court will consider you to have tendered a plea of no contest and submitted to a forfeiture, plus costs, fees, and surcharges, not to exceed the amount of the deposit.
b. You will be summoned into court to answer the complaint if the court does not accept the plea of no contest.
5. If you do not make a cash deposit and do not appear in court at the time specified, any of the following may happen:
a. The court may issue a summons or warrant for your arrest.
b. The court may consider the nonappearance to be a plea of no contest and enter judgment against you.
c. The town may commence an action against you to collect the forfeiture, plus costs, fees, and surcharges.
6. If the court finds that this violation involves an ordinance that prohibits conduct that is the same as or similar to conduct prohibited by state statute punishable by fine or imprisonment, or both, and that the violation resulted in damage to the property of or physical injury to a person other than you, the court may summon you into court to determine if restitution shall be ordered.
If you elect to make a cash deposit, pay the deposit to the official listed above, by the date listed above, and return a copy of this citation that is signed in the area designated below to indicate that you have read the statements listed in items 1 to 6, above.
[Signature of defendant]
Note: In an action against a corporation organized under ch. 180 or 181, Wis. stats., or against a limited liability company organized under ch. 183, Wis. stats., a citation must include a statement of the corporate or company existence and whether the corporation or company is a domestic or foreign corporation or limited liability company. See s. 800.02 (2) (ag) 9m., Wis. stats.
