The following statutes affect this form: ss. 170.05 and 172.06, Wis. stats. ________ ________, of the Town of ________, ________ County, Wisconsin, being first duly sworn, on oath says that the following is a true statement of the lawful charges incurred in taking up, keeping, advertising, and selling _______ [describe animal] [if applicable, together with a forfeiture of $5], notice of the taking up of which was filed with the clerk of the town on ________ ___, 20__:
Total $________
[Signature of finder]
Subscribed and sworn to before me this ____ of ________, 20__.
[Signature and title of officer]
Note: A finder who takes up an animal under s. 172.01, Wis. stats., is entitled to receive a forfeiture of $5 from the owner or keeper of the animal.
