HOMESTEAD POLICE DEPARTMENT

IMPLIED CONSENT WARNINGS

CASE :;J 0 GI 3 () 025--- ! CITATION: 23 6J
IOTHER CASE :
XEV
English / Ingles

I am now requesting that you submit to a lawful test of your BREATH for the purpose of
determining it's alcohol content.

I am now requesting that you submit ~o a lawful testof'you~URINc for the puCpqse of
detr
ining !he presence of chd1!_1ii;al or controll.l<t_substa

'

'

l 1am r\ow requesting -t hat y,ou sub~it to a iawful test of your LOOD for ~he purpose of

I\. _

determining it's alcohol content or the presence of chemical or controlled substances.

--........_

--

Will you take the test?

YES ISJ

NO D

ftead only if subject does not comply

If you refuse to submit to the test I have requested of you, your privilege to operate a motor vehicle will be suspended
for a period of one (1) year for a first refusa l, or eighteen (18) months if your privilege has been previously suspended
as a result of a refusal to submit to a lawful test of the breath, urine of blood Add1t1onally, 1f you refuse to submit to
the test I have requested of you and if your driving privilege has been previously suspended for a prior refusal to
submit to a lawful test of your breath, urine or blood you will be committing a misdemeanor Refusal to submit to the
test I have requested of you is admissible into evidence in any criminal proceeding

Espanol / Spanish
Alerta\ de consentimiento implicado
D

Estoy pidiendole en este mome to que se someta a un examen legal de su ALIENTO

con la finalidad de determinar su ontenido de alcohol.

Estoy pidiendole en este momento ue se someta a un examen legal de su ORINA con

la finalidad de determinar la presenc de quimicos o sustancias controladas.

Estoy pidiendole en este momento qu se someta a un examen legal de su SANGR E

con la finalidad de determinar su conten'do alcohlico y/o presencia quimicas o
s ustancias controladas.
Tomara el examen

NO D
D
Read only if subject do not comply
SI

S1 se mega a someterse al examen que le he solicitado, su privile o para operar un veh1culo motonzado sera
suspendido por un (1) ano por la primera denegacion, o d1eciocho ( 8) meses s1 su pnv1leg10 ha s1do suspend1do con
anterioridad como resultado de haberse negado a someterse a un ex men de ahento, onna o sangre
Adicionalmente, si se niega a someterse al examen que le he solicitad y si su privilegio para maneiar ha s1do
suspendido anteriormente por una previa denegac1on a someterse a un xamen legal de su aliento, onna o sangre
estara comet1endo un delito menor Negarse a someterse a el examen g le he solic1tado es adm1t1ble como
evidencia en cualquier proceso criminal

71

Print I Escriba

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Advising officer: Lf'{'( .A /Y)u IL. O) t : d u

Subject:

Witness:

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