2017 Indiana Code
TITLE 9. Motor Vehicles
ARTICLE 30. GENERAL PENALTY PROVISIONS
CHAPTER 6. Implied Consent; Administrative and Evidentiary Matters
9-30-6-16. Bureau certificate; form and contents

Universal Citation: IN Code § 9-30-6-16 (2017)
IC 9-30-6-16 Bureau certificate; form and contents

     Sec. 16. The bureau certificate must contain the following information and may be substantially in the following form:

BUREAU OF MOTOR VEHICLES

CERTIFICATE

Date of Arrest           Time       Driver's License No.             License State

a.m.

    /        /                       p.m.

Name: (first)             (M.I.)                (last)                 Date of Birth

                                                                                           /       /

CURRENT Address (street, city, state, zip)

Court Code   Cause Number     Sex    Weight    Height       Eyes      Hair

The above motorist                                     BUREAU USE ONLY

REFUSED alcohol test

                                         FAILED alcohol test 0.%

                                         Court Determination

It has been determined there was probable cause the defendant violated IC 9-30-5 this ___________ day of ________________, 20__ and that charges are pending herein.

_____________________ Court     ______________________ County

                                                         ____________________________

                                                                                     Judge's Signature

[Pre-1991 Recodification Citation: 9-11-4-16.]

As added by P.L.2-1991, SEC.18. Amended by P.L.2-2005, SEC.40.

 

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