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8/7/2008
Case Analysis Form
     
 

Please take a few minutes and fill out this DUI Case Report. It will give us a chance to review your drunk driving arrest case and then get back to you quickly.

* Indicates a required field

Contact Information
First Name *
Last Name *
Email Address *
Day Phone Number *
Night Phone
Case Details
What date were you arrested?
 
What police agency arrested you?
 
Which court are you supposed to appear in?
 
When is your first court date?
  
 
Was your car registration valid?
 
  Yes No
If not, why?  
 
Have you been convicted of DUI or a Wet Reckless within 10 years of this arrest?
  Yes No
If so, what year and which court?
 
Were you involved in an accident in this case?
  Yes No
If so, provide insurance policy.  
 
What was the reason(s) the officer gave for pulling you over in this case?
 
What was the make, model, color and year of your vehicle?
 
What were the cross streets where you were pulled over by the police officer?
 
What city and county were you pulled over in?
 
What did you tell the police about what you had to drink and when you consumed the drinks?
 
What time were you released from jail?
 
Under 21 years of age at the time of the arrest? Yes No
Any mechanical problems with your vehicle? Yes No
Was there a child under 14 years of age in the car? Yes No
Did you refuse to take a chemical test? Yes No
Was your blood alcohol level a .20 or higher? Yes No
If you were on the freeway, were you speeding over 30 mph beyond the posted speed limit? Yes No
If you were on surface streets, were you speeding over 20 mph beyond the posted speed limit? Yes No
If you were involved in an accident, were there any injuries to anyone in your vehicle or the other party's vehicle? Yes No
Did the officer ask you to perform a field sobriety test? Yes No
Did you perform a field sobriety test? Yes No
Did the officer advise you of your Miranda rights? Yes No
If so, did you waive your Miranda rights? Yes No
Did the officer ask you to blow into a hand held breath device at the scene? Yes No
If so, did the officer advise you that you had the right to refuse that on scene breath test? Yes No
If so, how many times did you blow into that on scene breath test?
At your arrest, were you advised that you had a choice between a blood or breath test? Yes No
If so, which did you take?
If you took a breath test, was the officer continuously observing you for fifteen minutes prior to the administration of that test? Yes No
If you took a chemical test (i.e., blood or breath test), do you know the result? Yes No
If so, what was the result?
If you took a breath test, how many times did you blow into the machine?
Check each box that applies:
I'm Diabetic
I'm Epileptic
I have dental work in my mouth.
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