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Statement_of_finder_s_charges 170.05 * Statement of finder's charges.

________ ________, 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 a _______ [describe stray] as a stray, notice of the taking up of which was filed with the clerk of the town on ________ ___, 20__, to wit:

Total   $________

[Signature]

Subscribed and sworn to before me this ____ of ________, 20__.

[Signature and title of officer]