2018 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 (2018)
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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