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Nonrenewal_revocation_or_suspension_of_license_notice 125.12 (2): Nonrenewal, revocation, or suspension of license; notice

The following statutes affect this form: s. 125.12 (2) and (3), Wis. stats.

STATE OF WISCONSIN
Town of ________
________ County

To ________ ________:

It appearing to the Town Board of the Town of ________, ________ County, Wisconsin, from the evidence presented that you sell [describe type of sale, as in license] in the town under a Class [A or B or C] license and that you violated [ch. 125, Wis. stats. or the following regulation adopted under s. 125.10, Wis. stats., or both: [specify violation as in complaint and nonappearance, if applicable], you are notified that your license is [revoked or suspended for ____ days or not renewed].

Dated this ______ day of ________, 20__.

[Signatures of town board]

Attest: [Signature of town clerk]