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:: CASE aNALYSIS ::

If you would like us to review your case and contact you, please fill out the information below:

Contact Information

First Name:


Last Name:


E-mail:


Day Phone number:


Night Phone number:


Case Details

Court you must appear in:


When is your first court date?


Was your car registration valid?
	Yes No

If not, why?


Have you been convicted of DUI or a Wet Reckless within seven years of this arrest?
	Yes No

If so, how many times, when, which court(s)?


Were you involved in an accident in this case?
	Yes No

If so, provide insurance policy.


What was the reason(s) the officer gave for pulling you over in this case?


What was the make, model, color and year of your vehicle?


What were the cross streets where you were pulled over by the police officer?


What city and county were you pulled over in?


What did you tell the police about what you had to drink and when you consumed the drinks?


What time were you released from jail?


Under 21 years of age at the time of the arrest?
	Yes No

Any mechanical problems with your vehicle?
	Yes No

Was there a child under 14 years of age in the car?
	Yes No

Did you refuse to take a chemical test?
	Yes No

Was your blood alcohol level a .20 or higher?
	Yes No

If you were on the freeway, were you speeding over 30 mph beyond the posted speed limit?
	Yes No

If you were involved in an accident, were there any injuries to anyone in your vehicle or the other party's vehicle?
	Yes No

Did the officer ask you to perform a field sobriety test?
	Yes No

Did you perform a field sobriety test?
	Yes No

Did the officer advise you of your Miranda rights?
	Yes No

If so, did you waive your Miranda rights?
	Yes No

Did the officer ask you to blow into a hand held breath device at the scene?
	Yes No

If so, did the officer advise you that you had the right to refuse that on scene breath test?
	Yes No

If so, how many times did you blow into that on scene breath test?


At your arrest, were you advised that you had a choice between a blood or breath test?
	Yes No

If so, which did you take?


If you took a breath test, was the officer continuously observing you for fifteen minutes prior to the administration of that test?
	Yes No

If you took a chemical test (i.e., blood or breath test), do you know the result?
	Yes No

If so, what was the result?


If you took a breath test, how many times did you blow into the machine?
	Yes No

Check each box that applies:
	I'm Diabetic
	I'm Epileptic
	I have dental work in my mouth.

Additional Comments

Wagner & Zielinski, APC
3454 E. Anaheim Street
Long Beach, CA 90804
Toll Free: (800) 931-0450
Fax: (562) 597-0414
Email: info@wzlawyers.com