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 [
chapter 125, Wis. stats. and/or the following regulation adopted under
s. 125.10, Wis. stats.: [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__.