First Name

Last Name

Email

Phone

Driver's License Number

Date of Birth

Court where you are to appear

Date you are scheduled to appear

Is this your first DUI?

Are you currently on probation or parole?

Have you requested your DMV Hearing?

Date of Arrest

Time of Arrest

City Where Arrested

Which law enforcment agency arrested you? (Ex: California Highway Patrol)

Did the officer observe you driving a vehicle?

Did you admit to driving the vehicle?

Was there an accident?

Were you stopped at a road block?

Were you under 21 years of age at the time of arrest?

Was there a child under 14 years of age in the vehicle at the time of arrest?

If you were on surface streets, were you speeding 20 MPH or more beyond the posted speed limit?

If you were on surface streets, were you speeding 30 MPH or more beyond the posted speed limit?

Did you tell the officer you had been drinking?

What time did you tell the officer that you had your last drink?

Did you perform any field sobriety tests?

Did the officer ask you to blow into a handheld breath device at the scene?

How many times did you blow into the breath device?

At your arrest, were you advised that you had a choice between a blood or breath test?

If you took a breath test, was the officer continuously observing you 15 minutes prior to the administration of that test?

If you took a chemical test (i.e., blood or breath), do you know the result?

If you took a breath at the station, how many times did you blow into the machine?

Were there any witnesses to your driving and/or arrest?

Did the officer advise you of your Miranda Rights?

Are you aware if you were video-taped at anytime during your arrest?

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