Gorospe and Smith P.L.L.C.

First Name:

Last Name:

Date of Arrest:

Place of Arrest:

Phone:

State of Driver's License:

E-mail:

Who arrested you?
City Police County Sheriff Campus Police

Was there an accident?
No Yes, single car accident Yes, multi car accident

Have you been arrested for DUI, APC, or DWI before?
No Yes

Have you been convicted of DUI or DWI within the last 10 years?
No Yes

What was the reason for being stopped for DUI?
Speed U-Turn Red Light Wrong Way Weaving Crossing Line Traffic Violation Equipment Problem Other

Did you take any standard field sobriety tests (pen test, heel to toe, etc.)?
No Yes Refused

Did you take a breath test?
No Yes Refused Test wasn't offered Was given a blood test

What were your breath test results?
Sample 1

Sample 2

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