STATE OF WISCONSIN
Town of ________
________ County
Whereas, ________ ________ and ________ ________ cannot agree as to the amount of charges incurred in relation to, or upon what should be allowed for the use of [describe stray], which was, on ________ ___, 20__, found and taken up as a stray upon the lands of ________ ________, a resident of the town, and has been kept by ________ ________ from that time to the date hereof, and which is now claimed by ________ ________; and ________ ________ has made application to me, the undersigned, chairperson of the Town of ________, to settle the matters in difference, whereof due notice was given to ________ ________;
Now, therefore, upon due inquiry and examination of witnesses on oath, I have ascertained, and do hereby adjudge, that the reasonable charges for keeping the stray, over the value of the use thereof, amount to $________; and the costs herein amount to $________.
Dated this ______ day of ________, 20__.
[Signature of town chairperson]
