10390 39th Street North
Suite 3

Lake Elmo, MN 55042

E-mail: beau@mcgrawlawfirm.com
Phone: 651.209.3200
Fax: 651.209.0550

 
 
Required Information:
First Name:
Last Name:
City of Residence:
City of Arrest:
Preferred Phone:
Best Time to Call:
Email Address:
Please Explain Your Situation:

Additional Information (each question is optional):
Home Phone:
Work Phone:
Note: Only provide your work phone number
if you don't mind being contacted at that number.
Cell Phone:
Date of Arrest:
Time of Day of Arrest:
Arresting Agency:
Why were you stopped?
Does the officer claim you were exceeding the speed limit by over 20 mph?
Yes No
Was a DUI Sobriety Checkpoint involved?
Yes No
Was an accident involved?
Yes No
If so, were there injuries?
Yes No
Did you have any passengers?
Yes No
If so, were any of them under the age of 18?
Yes No
Did you take any field sobriety tests?
Yes No
If so, how do you think you did on the tests?
Did you have any physical or medical conditions that may have affected your performance?
Yes No
What is your age?
How much do you weigh?
Did you take a "handheld" breath test in the field?
Yes No
If so, what was the result?
How many times did you blow into the device?
Were you given a breath test later at the police station?
Yes No
If so, what was the result?
How many times did you blow into the device before there were two readings?
Are you aware of any physical or medical conditions that could have affected the results?
Yes No
Was a blood sample taken from you?
Yes No
Were you given the choice of blood or breath?
Yes No
Did you refuse to be tested?
Yes No
If so, did an officer give you an "implied consent" warning of the consequences of refusing?
Yes No
Did you sign any document concerning the refusal?
Yes No
After the refusal, was a blood sample forcibly taken from you?
Yes No
Did you make any statements to the officer(s) concerning drinking and/or driving?
Yes No
Were you advised of your Miranda rights?
Yes No
Did you have a currently valid Minnesota driver's license?
Yes No
If not, is your license from another state?
Yes No
Was your license confiscated?
Yes No
If so, were you given a "Notice of Suspension"?
Yes No
Have you contacted the DMV Drivers Safety Office to demand a hearing?
Yes No
Was the vehicle impounded?
Yes No
Were you required to post bail?
Yes No
If so, how much?
Is this your first offense?
Yes No
When have you been cited into court for arraignment?
What is the name of the court?
Is a driver's license necessary for your employment?
Yes No
What is your occupation or profession?


 



 

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