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FREE Drunk Driving Case Evaluation

All Information Submitted is Kept Strictly CONFIDENTIAL by McDERMOTT LAW FIRM

If you are facing a drunk driving charge, get a FREE consultation for your case. Just complete the form below and submit it to us, or you can call our office at (727) 367-1080.

Please Note: "*" Represents a required field.

Name
Address
City
State
ZIP
Phone #
Can we contact you at this number?	Yes No
Second Phone#
Can we contact you at this number?	Yes No
FAX
Can we fax you at this number?	Yes No
*Email (required)	*
How did you find this web site?
Are you mainly interested in fighting your DUI, or do you want to plead nolo or guilty?
Date of Arrest
Time of Arrest
Day of the Week
City Where Arrested
County Where Arrested
Court Date (leave blank if unsure)
Time of Court
Name of Court
Driver's License #
State Where Licensed
Date of Birth
Is this your first DUI in your lifetime--anywhere, anytime?	Yes No
WARNING - If you were driving on a license suspended for DUI, your automobile is subject to civil forfeiture. If you have had prior DUIs please list them below:

Month/Year--------Court-------Result (Guilty, Not Guilty, Nolo)

Are you currently on probation or parole?	Yes No
If "yes", where?
Other Tickets/Charges received with this DUI (check all that apply):	Failure to Maintain Lane Speeding Illegal U-Turn Running Red Light Defective Equipment No Proof of Insurance Failure to Yield Other (Please specify below...)

Please specify other charges not listed above

Why were you stopped/arrested, according to officer?

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 Passenger(s) in another 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 Refused
Which field sobriety tests were you given? (Check all that apply)	Handheld Breath Test Walk-and-turn 9 steps heel to toe One-Leg Stand Follow-the-Pen-With-Eyes Say the Alphabet Touch Your Nose Other (Please specify below...)
Please specify other tests you took, that are not listed above
Did the officer videotape the incident?	Yes No
Did you take breath test?	Yes No, I Refused No, Test Was Not Offered to Me No, I Was Given a Blood Test Not Sure

WARNING: IF YOU REFUSED THE BREATH TEST OR WERE CHARGED WITH REFUSING THE TEST YOU FACE AN AUTOMATIC SUSPENSION OF YOUR LICENSE. YOU HAVE 10 DAYS FROM THE DATE OF YOUR ARREST TO FILE A REQUEST FOR A FORMAL HEARING WITH THE DEPARTMENT OF MOTOR VEHICLES. LIKEWISE, IF YOU SUBMITTED TO A TEST WHICH YIELDS A RESULT OF 0.08 OR MORE, YOU CAN ALSO BE SUSPENDED. CALL OUR OFFICE IMMEDIATELY FOR ASSISTANCE! (727) 367-1080

If you took a breath test you should have a print out of the two test samples. List your breath test results here:	Sample #1 Sample #2
Name of police department
Street or location where stopped
County where stopped
Was your car towed?	Yes No
Who called the tow truck?	I Did Officer Did Not Sure
At any time during your arrest did you ever ask for or inquire about getting your own independent blood, breath or urine test?	Yes No

Any Additional Comments:

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We Accept:

7116-A Gulf Blvd.
St. Pete Beach,
Fl. 33706
(727) 367-1080
law@flacrimlaw.com
http://www.flacrimlaw.com