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Free!! Case Evaluation
 

*First Name: *Last Name:
Street Address:
City: State: Zip:
Contact Phone: Fax Number:
*Email Address:
How do you wish to be contacted?
Are you mainly interested in fighting your DUI, or do you want to plea bargin?
Time of Arrest: Day of Week: State Where Arrested:
City Where Arrested: County Where Arrested: Court Date
Time of Court:
State Where Licensed: Date of Birth:
If you have had a prior DUI(s), please list them below:
Other Tickets/Charges received with this DUI (Check all that apply):
None
Speeding
Illegal U-Turn
Running Red Light or Stop Sign
Defective Equipment
No Proof of Insurance
Failure to Yield
Other (Please specify below):
Was there an accident? Yes  No  Not Sure
Was anyone injured? (Check all that apply):
No one was hurt/Not applicable
Myself
Passenger(s) in my vehicle
Pedestrian
Not Sure
Were you stopped at a roadblock? Yes  No
Were you given field sobriety tests at the location where you were stopped? Yes  No  Don't recall  I refused
Which field sobriety tests were given? (Check all that apply):
None
Hand held breath test
Walking heel to toe
One-leg stand
Follow-the-pen-with-eyes
Say the alphabet
Touch your nose
Other (Please specify below)
Did you take a breath test?
Yes
No, I refused
No, test was not offered to me
No, I was given a blood test
I was given all three tests - blood, breath and urine
Not sure
List your breath test results here: Sample #1:
Who posted bond? I did  Family Member/Friend  Other
Amount of bond:
Were there any witnesses with you who could testify for you? Yes  No
At anytime during your arrest, did you ever ask for or inquire about getting your own independent blood, breath or urine test? Yes  No
Did you get an independant blood, breath or urine test? Yes  No
If "yes", what was the result?
Did you ever ask to call an attorney? Yes  No
If "yes", when (Give Details)?
Additional Comments:
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Andrew T. Coiner
629 Washington St. Paducah, KY 42001
Tel: 270-442-9268 Toll Free: 1-877-442-9268
Email: acoiner@paducahlawyer.com

1-800-NOT-GUILTY
(McCracken, Graves, Livingston, Ballard, Marshall, Lyon, Carlisle, Calloway, Hickman, Caldwell, Fulton and Crittenden Counties)

 

Copyright © 2005 Andrew T. Coiner.  All Rights Reserved.