Wisconsin Administrative Code › Cosmetology Examining Board › Chapter Cos 10 - FORFEITURES › Appendix I

Current through June 24, 2024
State of Wisconsin
Department of Safety and Professional Services
Division of Enforcement
CITATION
_____________________________________________________________
Name of Credential Holder/Establishment
_____________________________________________________________
Street City Zip
_____________________________________________________________
Establishment/Owner License #
An investigation/inspection has disclosed the following
				violations, which must be corrected. Pursuant to s.
				454.15(3),
				Wis. Stats., the licensing authority is authorized to impose a forfeiture in
				lieu of or in addition to other disciplinary action against your
				license.
_____________________________________________
Day of Week Date Time
On the above stated time, date and location, the
				above-identified credential holder (describe violation - state facts.)
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
in violation of Section(s) _______________ of the Wis. Stats.
				Wis. Adm. Code.
__________________________________________________________________
Signature of Investigative Staff Title
PLEASE TAKE NOTICE that the credential holder may deposit a
				FORFEITURE and costs in the amount of ________________ by mailing a check or
				money order by no later than twenty (20) days from the date of this citation in
				the amount of the forfeiture, together with the signed white copy of this form
				to: the Department of Safety and Professional Services Division of Enforcement,
				1400 East Washington Avenue, PO Box 8935, Madison, WI 53708.
Payment
				shall be treated as a plea of no contest to the violation(s) cited above and
				submission to an order of forfeiture plus costs, not to exceed the amount of
				the deposit
.
State of Wisconsin
Department of Safety and Professional Services
Division of Enforcement
CITATION
_______________________________________________________________________
Signature of Licensee/Establishment Owner Date
FURTHER NOTICE that within twenty (20) days of the date of
				service of this citation, the licensee may enter a plea contesting the
				violation(s) cited and request a hearing on the alleged violation(s).
				Submission of a plea contesting violations and requesting a hearing shall be in
				writing and submitted to the Department of Safety and Professional Services
				Division of Enforcement, 1400 East Washington Avenue, PO Box 8935, Madison, WI
				53708.
If the credential holder does not make a deposit or otherwise
				respond to the citation in a timely fashion, the disciplinary authority may
				without further proceedings issue an order of default against the credential
				holder. A default order issued under this section may impose forfeiture and
				costs, not to exceed the amount identified in the citation. Violation of an
				order issued pursuant to this section may result in a refusal to renew
				credentialing or additional disciplinary action.
If the credential holder requests a hearing but fails to appear
				at the hearing at the time fixed therefor, the credential holder is in default
				and the disciplinary authority may make findings and enter an order on the
				basis of the citation.