Law Offices of Robert Tayac
www.ca-dui.com

DUI/DWI Questionnaire

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1. Did the Officer confiscate your driver's license, or give you a paper called "Administrative Per Se Order of Suspension/Revocation, Temporary Driver License Endorsement"?

2. Have you contacted the DMV as requested on the Administrative Per Se Order?:
Yes
No
If not, immediately call us at 800-901-1888

3. If you have contacted the DMV within the 10 day limit, when is your appointment (date and time)?:

4. Have you ever been arrested for a DUI/DWI charge before?
Yes
No

5. Were you stopped at a DUI sobriety checkpoint?:

6. Approximately how many minutes went by from the time you were arrested (when they handcuffed you) until you arrived at the chemical test location (blood, breath or urine test location)?:

7. Approximately how many minutes went by from the time you arrived at the chemical test location until you took the first chemical test (blood, breath or urine test)?:

8. Were there any passengers in you car at the time you were stopped?:
Yes
No

9. Were you involved in accident?:
Yes
No

     If yes, was anyone injured?:
     Yes
     No

10. Did you admit to driving?:
Yes
No
I don't know/not applicable

11. If you consumed alcoholic beverages, what type did you drink(s) (highlight all that apply)?:
None consumed Beer-Regular Beer-Malt Liquor Beer-Bock Beer-Double Bock Wine Cooler Ale Champagne Wine Mixed Drinks Vodka Rum Gin Tequila Whiskey Scotch Bourbon Schnapps Cognac Alize Ripple Thunderbird Port Rubbing Alcohol Can't remember Other

12. Were you asked any questions concerning your drinking of alcoholic beverages?:
Yes
No

     If yes did you admit to drinking?:
     Yes
     No

13. Think about the drinks you had. Many people under estimate how many drinks they had, or cannot remember. However, this is extremely important to your case. In order to calculate your Blood Alcohol Level please indicate how many drinks you had total (one drink is equal to a 12 ounce beer, a regular glass of wine, or 1 shot (1 1/4 ounces of hard liquor)?:
None consumed One (1 drink) Two (2 drinks) Three (3 drinks) Four (4 drinks) Five (5 drinks) Six (6 drinks) Seven (7 drinks) Eight (8 drinks) Nine (9 drinks) Ten (10 drinks) 11+ drinks Can't Remember Blacked Out

14. Approximately what time did you finish your LAST alcoholic beverage before you were pulled over?:
I don't know/not applicable

15. What time did you tell the officer you last drank?:

16. If you were on prescription medications or other drugs, what type? ?:

17. What size meal did you have before the arrest?:
Hadn't eaten within the time limit Bar Snacks Small meal Medium meal Large meal Extremely large meal

18. When, before the arrest, did you eat?:

19. Did you perform any coordination or balance tests (Field Sobriety Tests - FST's) prior to being arrested?:
Yes
No
I don't know/not applicable

20. Please select the field sobriety tests you were requested to perform? (check all that apply):
- Did not take any field tests
- Follow a pen, finger, or other object with you eyes, not moving your head
- Standing with my head tilted back and eyes closed, feet together
- Standing on one foot for a period of time and counting
- Patting your hands together
- Counting on your fingers
- Saying or writing the ABC's
- Walking a straight line, or heel-to-toe
- Touching your nose with finger
- Other

21. If 'Other', please indicate what they made you do?:
I don't know/not applicable

22. Did you submit to a hand held breathalyzer test?:
Yes
No

23. If you know, what was the result of the hand-held breathalyzer gadget test?:

24. Did the officer advise you that you could refuse to take the hand-held gadget breath test?
Yes
No
I don't know/not applicable

25. Did you fail to satisfactorily perform the balance and coordination tests as demonstrated to you by the officer?:
Yes
No
I don't know/not applicable

26. Please select the type of chemical test you took (or whether you took a chemical test at all):
Blood
Breath
Urine
No Chemical Test Taken
I don't know/not applicable

27. What were the results of the test, if you know?:
I don't know/not applicable

28. Did you take the chemical test (blood, breath or urine at the station or jail) within 1 1/2 hours after finishing your last drink?:
Yes
No
I don't know/not applicable

29. If you are charged with refusing a chemical test - Which of the following apply?
The cop told me I would have my license suspended if I refused a
blood, breath or urine test, and I refused anyway.
I refused during the initial vehicle stop or contact with the cop.
I refused when they handcuffed me.
I refused in the patrol car.
I refused on the ride, in the patrol car, to the chemical test location.
I refused at the chemical test location.
I refused everything from the beginning.
The cop told me I refused when he first stopped me.
The cop told me I refused when we were doing Field Tests.
The cop told me I refused when he handcuffed me.
The cop told me I refused when we were in the car.
The cop told me I refused when we were driving to the chemical test location.
The cop told me I refused when we were at the chemical test location,
but he didn't tell me I would lose my license if I refused.
The cop told me I could refuse the test when he used a hand-held breathalyzer, so I did.
The cop never told me I had to take a test and he didn't tell me I
would loose my license for refusing.
Other

30. If "other", please explain what happened:

31. After you arrived at the place where the breath machine was located, did you wait at least 15 minutes before your first breath into the machine?:
Yes
No
I don't know/not applicable

32. If at least 15 minutes went by after arriving where the breath machine was located, what were you and the officer(s) doing during that period of time (highlight all that apply)?
The officer(s) sat and watched me do nothing. The officer(s) were doing reports in my presence. The officer(s) were doing reports out of my presence The officer(s) were doing reports and talking with me and each other. I was sleeping. I was sick. I was vomiting. I was having indigestion. I was belching or burping. I was drinking. I was fighting with the cops I was getting my ass kicked by the cops Other

33. If 'Other', please indicate what happened?:

34. After the breath test was completed, did the officer advise you that you had the right to take a blood or urine test, in addition to the breath test, to insure the accuracy of the breath machine or so you could have a sample collected for future testing?:
Yes
No
I don't know/not applicable

35. Did you take an additional blood or urine test?
I did not give an additional sample. I wasn't sure if I should give an additional sample. I knew I was over the limit anyway. I can't remember. The officer(s) talked me out of doing it. The officer(s) told me it would be used against me also. The officer(s) didn't tell me about this right of mine. I gave a urine sample after the breath test. I gave a blood sample after the breath test. Other

36. For the urine test, did you completely empty your bladder the first time you urinated?:
Yes
No
I don't know/not applicable

37. If no, why not?:

38. For the urine test, did the officer collect your urine the second time you urinated?:
Yes
No
I don't know/not applicable

39. For the urine test, did an officer watch you closely or fail to respect your privacy when you provided the sample?:
Yes
No
I don't know/not applicable

40. What type of law enforcement officer was the arresting officer (the one who gave you tests, handcuffed you, took you to jail)?:
Sheriff City Police Officer Highway Patrol Undercover Narc Border Patrol Agent Airport Police Officer Federal Agent All I remember is that the fucker was huge Other Law Enforcement Officer

41. Please input the arresting officer's last name and badge or serial number if you know it:

42. In which California Superior Court are you scheduled to appear?:
-select one- (Alhambra) (Airport) (Beverly Hills) (Burbank) (Chatsworth) (Compton) (Culver City) (Downey) (East L.A.) (El Monte-Rio Hondo) (Fullerton) (Glendale) (Hollywood) (Huntington Park) (Inglewood) (Laguna Niguel) (Lancaster) (Long Beach) (Los Angeles-Bauchet St.) (Los Angeles-CCB) (Los Angeles-Metro) (Los Cerritos-Bellflower) (Lynwood) (Malibu) (Monrovia) (Newport Beach) (Norwalk) (Orange) (Pasadena) (Rio Hondo) (San Diego) (San Fernando) (San Pedro) (Santa Ana) (Santa Clarita) (Santa Monica) (South Gate) (Torrance) (Valencia) (Van Nuys) (Vista) (Westminster) (West Covina-Citrus) (Whittier)

43. In which Nevada Justice or Municipal Court are you scheduled to appear?:
-select one- (Boulder City) (Carson City) (Goodsprings) (Henderson) (Las Vegas) (Las Vegas North) (Laughlin) (Mesquite) (Moapa Valley) (Pahrump) (Reno) (Tonopah) (other)

44. Have you consulted with another attorney since your arrest?:
Yes
No

45. Are you aware that a conviction and/or driver's license suspension for DUI/DWI will result in an insurance cancellation or a possible increase in cost between $15,000 to $25,000 during the next seven years?:
Yes
No

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