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Personal Information:
*First name:
*Last name:
Cell Phone:
Home Phone:
*Email:
Contact Preference:
Call my Cell Phone
Call my Home Phone
Email Only Please
I will call
General Arrest Information:
Arrest Date:
[Month]
January
February
March
April
May
June
July
August
September
October
November
December
[Day]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2007
2008
2009
2010
Arresting Agency:
California Highway Patrol
San Diego Sheriff
San Diego Police Department
Harbor Patrol
Other
Did you have to Post Bail?
Yes
No
Was your car impounded?
Yes
No
Were you in an accident?
Yes
No
N/A
Was anyone injured?
Yes
No
N/A
Property Damage?
Yes
No
N/A
Passengers?
Yes
No
Specific Arrest Information:
Time of stop/contact:
Officer See you driving?
Yes
No
Don't Know
Did you "Follow the pen?"
Yes
No
Refused
Did you "Walk the line?"
Yes
No
Refused
Did you "Estimate 30 secs?"
Yes
No
Refused
Hand held Breath Test?
Yes
No
Refused
Hand held Device Reading:
(If the officer told you)
Chemical Test at Station:
Blood
Breath
Refused
Breath Machine Result:
(If notified)
Department of Motor Vehicle Information:
Aware of the 10 day rule?
Yes
No
Huh?
Was your license valid?
Yes
No
Not Sure
License issued from:
AL - Alabama
AK - Alaska
AZ - Arizona
AR - Arkansas
CA - California
CO - Colorado
CT - Connecticut
DE - Delaware
DC - District of Columbia
FL - Florida
GA - Georgia
HI - Hawaii
ID - Idaho
IL - Illinois
IN - Indiana
IA - Iowa
KS - Kansas
KY - Kentucky
LA - Louisiana
ME - Maine
MD - Maryland
MA - Massachusetts
MI - Michigan
MN - Minnesota
MS - Mississippi
MO - Missouri
MT - Montana
NE - Nebraska
NV - Nevada
NH - New Hampshire
NJ - New Jersey
NM - New Mexico
NY - New York
NC - North Carolina
ND - North Dakota
OH - Ohio
OK - Oklahoma
OR - Oregon
PA - Pennsylvania
RI - Rhode Island
SC - South Carolina
SD - South Dakota
TN - Tennessee
TX - Texas
UT - Utah
VT - Vermont
VA - Virginia
WA - Washington
WV - West Virginia
WI - Wisconsin
WY - Wyoming
Officer take your License?
Yes
No
Commercial license?
Yes
No
Contacted the DMV?
Yes
No
Huh?
Court Information:
First Court Date:
[Month]
January
February
March
April
May
June
July
August
September
October
November
December
[Day]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
2007
2008
2009
2010
Court Location:
Chula Vista (South Bay)
El Cajon (East)
San Diego (Downtown)
Vista (North)
Other
If applicable:
Previous Conviction Date:
[Month]
January
February
March
April
May
June
July
August
September
October
November
December
[Day]
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
N/A
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
Court for previous DUI:
Chula Vista (South Bay)
El Cajon (East)
San Diego (Downtown)
Vista (North)
Other
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