YOUR DUI CASE INFORMATION SHEET

       In order for your attorney to represent you properly he must have all the information requested below. Therefore it is necessary you answer all the questions below as carefully and completely as you can. All information is protected by attorney/client privilege and cannot be disclosed under any circumstances.

       Please do not rush through the questions. Take time to think about your answers and be as accurate as possible.  If you obtained any information from someone else, please indicate where or whom the information came from, appropriate addresses and phone numbers were necessary.

       Please include the relevant facts, such as conversation with the police, witness(es), etc.  If you have any doubt whatsoever about something, write it down and we can discuss it.  It is better to be to through then to possibly leave something out.

       BE SURE THE INFORMATION IS ACCURATE. IF YOU ARE NOT SURE OF SOMETHING THEN SAY SO. In general, at this time, the length of answers should be about the size of the space allowed for them. If you do need to give a longer answer please attach a separate sheet. Don't forget to include the item number on that sheet.

       Take your time and think about your answers. Try to remember everything you can. You're doing this for yourself, so do it carefully. After you are finished set it aside a few days, then go over it again. You will have thought of a few more things to put down by then.

YOUR ATTORNEY NEEDS TO KNOW EVERYTHING.

INFORMATION ABOUT YOU

1.  Todays Date: _____________

2.  Full Name: ____________________   a.k.as _______________ Date of Birth: __________

3.  Mailing Address: ___________________________________________________________

4.  Telephone(s): _________________________Fax: ________________Email: __________

5.  Occupation: __________________________ Work Telephone: ______________________

6.  Employment Address: ______________________________________________________

7.  Marital Status: _________ Spouses Name: ________________ Children: ______________

8.  Residence Address: ________________________________________________________

 

INFORMATION ABOUT WHAT HAPPENED

1.  Date of arrest: _________________________ Time of Day: ________________________

2.  Where: _______________________________ Who was with you? __________________

3. Police agency: __________________________Citation No._________________________

4. Do you have a valid Arizona Driver's License? _____ If "No", then please explain:
___________________________________________________________________________
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5. Was there an accident? ____ If "Yes", then please answer the following, otherwise skip to

number 6. What happened, include whose fault it was, and why:
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       Your insurance agent's name, address and phone number (I must contact them to obtain a

letter for the court showing that you were insured):
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       Other party's insurance agent:
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       Was anyone injured? _____ If "Yes" then tell who, and describe their injuries:
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6. Have you ever been convicted of drunk driving or driving with a suspended or revoked license before? _______    If "Yes", then answer the following, for each conviction:

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7. Describe the circumstances of how you were driving, and where, at the time of your arrest:
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8. What did the cop say he pulled you over for?
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9. Were there any distractions, such as high winds, bad road, radio, cigarette, or perhaps steering or brake problems with the car, etc.?
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       Make, model, year of car:
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       Does the car have an exhaust leak?
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10. Did you pull right over for the police, or was there a delay? If delay, then why?
___________________________________________________________________________
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11. Place you stopped and were arrested (Street address if available, describe landmarks):
___________________________________________________________________________

 

12. Where had you been coming from and where were you going at the time of your arrest? Give the last place you were coming from, and your immediate destination. Be specific, addresses, names and phone numbers, if known: ___________________________________________________________________________
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13. Were there any witnesses to your arrest in addition to yourself and the arresting officer? ____ If "yes", give what you know of their name, address, phone number, and tell where they were, and what they may have witnessed. (Don't forget other cops and onlookers, even those who may have seen something from nearby buildings):
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14. What kind of drinker are you? (check One)

___ Nondrinker
___ Beginner
___ Novice
___ Experienced
___ Professional
___ Alcoholic
___ Alcoholic not drinking anymore (Except for occasional slip ups)
___ Other (Describe):
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15. Were you drinking before your arrest? ____ If "Yes", then answer the following, for each place you consumed alcohol prior to your arrest, starting with the first place, and ending with the last:

(This is very important. Take the time to give every detail. If you left a place you later returned to then please do say so. This should be as detailed as possible. Don't leave anything out. You may need an extra sheet for this one.) ___________________________________________________________________________
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How much did you weigh at the time of your arrest? _______

16. Give the following information for each place you were at the day you were arrested, starting with when you woke up: (Don't include places you mentioned just above in #15.)

(This is also very important. Take the time to give every detail. If you left a place you later returned to then please do say so. This should be as detailed as possible. Don't leave any thing out. You will very likely need an extra sheet for this one.) ___________________________________________________________________________
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17. Were you dozing off while driving? ____ If "Yes", why?
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18. When did you last eat before your arrest, and what?
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       If not a full meal, when did you last have a full meal, and what?
_____________________________________________________________________

19. Do you have diabetes, false teeth or holes in your mouth that can hold alcohol, or any kind of balance problem? (Describe.)
___________________________________________________________________________

 

Doctor's name, address, and phone number if you have any of these conditions, and have been treated for them:
___________________________________________________________________________

20. Had you consumed any sort of prescription/legal drugs prior to your arrest (even aspirin)? ___ If "Yes", describe fully:
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21. Were you around any chemicals or substances prior to your arrest that could have made you dizzy or appear to be under the influence of alcohol? ___ If "Yes", please describe fully:

22. You obviously weren't dead or in a coma at the time of the arrest. That's two of the ways that alcohol can affect the body. There are three other possibilities of how your body was affected by alcohol at the time of your arrest. These three other ways are not matters of certain fact, like death or being in a coma. They are matters of opinion. The three other ways alcohol could affect you are: You may have been drunk. You may have been under the influence  or impaired. Or you may have been sober. Which one you were is a matter of opinion, not cold, hard fact. In addition, these terms do not have their normal medical meaning here. They are legal terms, with legal definitions.

"Drunk" means: not able to care for your own or others safety. Sort of a bleary stupor where you could get hurt and not know what's happening. You probably weren't drunk. "Under the influence" means: affected to the slightest degree which is presumed to render you not capable of driving in the way a normally cautious and prudent person would, due to the consumption of alcohol or drugs. If you felt like you could drive as safely as the normally prudent person would, then, in your opinion at least, you were not under the influence, or impaired to the slightest degree because you were "Sober". "Sober" just means that you weren't one of the other four states related to alcohol's affect on the body. If you felt you could drive safely, as the normally cautious and prudent person would, then you can truthfully state that you were sober.

WERE YOU SOBER? ____ (If "No" you must have been either under the influence or drunk, therefore guilty!!)

23. Please check which of the following field sobriety tests you may have been given, and describe how you did on each, include conversations:

                               Walking a straight line, heel to toe:
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                               Saying the alphabet:
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                               Touching tip of nose:
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                               Staring up at sky:
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                               Following an object with eyes:
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                               Standing on one foot:
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                               Counting:
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                               Picking up things:
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                               Other:
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                               Other:
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24. Did the cop ask you if you were drinking, or how much you drank, or if you were driving? If so, then when were you asked, and what did you and the cop say? Please give detailed conversation in the order it occurred:
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25. After there was probable cause to arrest you, your statements to the police, in response to their questions, cannot be used against you in court if you were not first advised of your "Miranda" rights. That is the right to remain silent, and have a lawyer present when you are being questioned. Were you advised of these rights? _____ Did you agree to talk to the police? _______. After you were arrested were you asked any questions which you answered? If so, give details of what you were asked, and the answers:
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Did you voluntarily tell the police anything even though you were not asked? Describe fully: ___________________________________________________________________________

26. Did you take a test for blood alcohol level, either a blood test, a breath test, or a urine test? ______ If "No", please state why (It's O.K. not to, if you have a plausible reason to counter the D.A.'s claim that you refused because you knew you were guilty.)
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       If you took a breath test by the roadside, prior to being placed under arrest, were you advised that you didn't have to do that? ____ The test result: 0. ___%

       If you took a blood test either at roadside, at the police station or at a hospital, were you informed that a sample would be preserved for you. ___________.  Were you given anything in writing attesting to this fact.   Before of after the blood test, were you advised of your right to have an independent test at your own expense. ____________________.

27. Is there anything else said by you or the police that you have not previously described? If so, please do: ___________________________________________________________________________
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28. If applicable, what date time did you get out of jail? ___________________________________________________________________________

29. Are you on probation for anything? If so, describe fully, with court, offense, and time periods:
___________________________________________________________________________

30. If you have any criminal record, please describe fully:
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31. Describe any offenses or accidents on your driver's license record: ___________________________________________________________________________

32. Please use the space below and on the back, to give your attorney any other information you think may be important. (Come on, there must be something!)

DON'T FORGET TO GO OVER THIS ENTIRE QUESTIONNAIRE AGAIN IN A COUPLE OF DAYS, TO PUT DOWN ANYTHING ELSE YOU MIGHT HAVE THOUGHT OF.

When completed send to:

LAW OFFICE OF DAVID ALAN DARBY

P.O. Box 12427

Tucson, Arizona 85732

Or

FAX to: 520-620-0818

Or

Email to: david@arizona-dui-defense.com