2022 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
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.