Heidi Honis

 

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DUI Info

This is a secure form. All information herein will be kept confidential.

Contact Information
 
Full name:
(as shown on citation)
 
E-mail address:
 
Address:
 
City:
State:
ZIP:
 
Main phone:
 
 
Work phone:
 
 
Other phone:
 
Date of arrest:
/ /  
Referred by:
10 Day Rule Questionnaire
 
The following questions are about the BAC (blood alcohol concentration) tests. This includes the Breathalyzer, Blood, and Urine Tests.
 
Did you refuse take a BAC test?
Yes No  
 
Did you try to take the test but they said you refused?
Yes No  
 
Did you score at or above a 0.08?
Yes No  
 
Were you under 21 and scored at or above a 0.02?
Yes No  
 
Did you have a CDL, were in your work vehicle and scored at or above a 0.04?
Yes No  
 
Are you not sure what you blood alcohol level was?
 Yes No  
 
Did you get a yellow piece of paper "8 1/2 inches by 11 inches" entitled "Sworn Report of the Arresting Officer"?
Yes No  
  If you answered 'Yes' to any of the above questions, you must file for a special hearing within 10 days from the date of your arrest. Failure to do so will result in a 1-year suspension of your license.
     
 
You can now submit the above portion of the form for contact purposes or fill out the rest of the form and submit for your free evaluation.
     
Free Evaluation Section
 
Driver's License No.:
State:
DOB
 / /
 
Full name of Court:
 
How many DUIs have you had:
 
 
Month and year of prior:
1. 2. 3.
 
Tickets and other citations received with this DUI:
 
Arresting officer:
 
Type of officer:
Task Force:
 Yes No
 
Accident:
Yes No
 
Roadblock:
Yes No
 
Open container:
Yes No
 
Did you take the Breath Test?
Yes No
Reading:
    
 
Reason for Refusing:
 
Did you take the Blood Test?
Yes No
Reading:
    
 
Did you take the Urine Test?
Yes No
Reading:
    
 
Did you get an independent blood or urine test?
 Yes No
Hospital:
 
Street where stopped:
 
County:
 
Why stopped?
 
Names of witnesses:
 
Bondsman:
 
Has arraignment already occurred?
Yes No If yes, please answer the following:
 
Judge:
 
Date of arraignment:
/ /
 
Plea entered:
 
Were you represented?
Yes No
By whom?
 
Were any motions filed?
 Yes No    
  Please give a detailed description of what happened. Include everything that you can remember.