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What was the date of arrest of the most recent incident?

Was there an accident in the present case?

Yes
No

Were any "field sobriety tests" conducted?

Yes
No

If yes, which ones?

Did you refuse to take a test?

Yes
No

Do you have your test results now?

Yes
No

If yes, what are they?

When is your court date? and at what court location?

Was your license under suspension at the time of this arrest?

Yes
No

Have you received a notice from the Department of Motor Vehicles (DMV) about a suspension of your license?

Yes
No

If yes, what is the last date for requesting a hearing?

Have you ever been arrested or convicted before for Drunk Driving/DWI/DUI?

Yes
No

If yes, how many prior cases do you have?

Have you used the Alcohol Education Program (AEP)?

Yes
No

If yes, when?

Please provide any information you think is important about your situation.


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