Legal DUI Blood Warrant Application

LEGAL DUI BLOOD WARRANT APPLICATION

Applicant Name:    Badge/ID:    Agency:

Respondent Name:    Date of Birth:

Incident Date and Time:    Location:

RECITALS

WHEREAS, Applicant is a law enforcement officer employed by the agency identified above and, based upon personal observations and investigation, has probable cause to believe that Respondent committed the offense of driving under the influence of alcohol and/or drugs on the date and at the location set forth above; and

WHEREAS, the facts and circumstances supporting probable cause are set forth in the affidavit below, including observable indicia of impairment, results of field sobriety tests, statements by the Respondent and witnesses, medical evaluation where applicable, and any refusal to consent to chemical testing; and

WHEREAS, Applicant requests issuance of a warrant authorizing the collection of a blood specimen from Respondent by qualified medical personnel to determine blood alcohol concentration and presence of intoxicants, and to preserve such evidence in accordance with law.

NOW, THEREFORE, Applicant applies to the issuing judicial officer for a warrant pursuant to applicable law authorizing the drawing of blood from Respondent for chemical analysis and sets forth the following information and affidavit in support of that application.

1. AFFIDAVIT OF PROBABLE CAUSE

Summary of Observations (articulable facts supporting probable cause):

Additional facts known to Applicant that bear on impairment, injury, or evidence preservation:

2. INDICIA OF IMPAIRMENT / TESTS

Observable indicators (check all that apply):

Slurred speech Bloodshot or watery eyes Odor of alcohol

Field sobriety tests administered and results:

3. REFUSAL, CONSENT, OR INCAPACITY

Respondent's consent status (check applicable):

Refused to consent to blood draw Medically incapacitated or unconscious Unable to provide consent for medical reasons

4. PERSON, VEHICLE, AND PLACE OF COLLECTION

5. SCOPE OF WARRANT REQUESTED

Applicant requests a warrant authorizing the following actions:

a. That a qualified physician, registered nurse, or other qualified medical professional be authorized to collect a venous blood specimen from Respondent for the purpose of determining blood alcohol concentration and the presence of controlled substances.

b. That law enforcement officers and authorized medical personnel may use reasonable force to effect collection if necessary and only to the extent permitted by law and medical practice.

6. CHAIN OF CUSTODY / EVIDENCE HANDLING

Procedures to preserve evidence integrity: Specimens shall be labeled with respondent name, date/time of draw, collector name, and sealed in tamper-evident packaging. Specimens shall be delivered to the laboratory designated by the investigating agency and stored under secure conditions until testing and final disposition.

7. REQUEST TO THE ISSUING JUDGE OR MAGISTRATE

Applicant requests that the issuing judicial officer review the affidavit and, upon finding probable cause, sign a warrant authorizing the actions described herein. Applicant certifies, under penalty of perjury, that the statements contained in this application are true and correct to the best of Applicant's knowledge.

8. FINDINGS AND AUTHORIZATION (FOR COURT USE)

Judicial officer determination (check one):

Warrant issued authorizing blood draw as requested Warrant denied

GOVERNING PROVISIONS

Governing Law: This application and any warrant issued pursuant hereto shall be governed by the laws of the jurisdiction in which the offense is alleged to have occurred and by the applicable rules concerning search warrants and compelled medical testing.

Entire Agreement: This application, including the affidavits and attachments incorporated by reference, constitutes the complete statement of probable cause submitted by Applicant to the issuing judicial officer and supersedes all prior oral statements on the subject made to the judicial officer by Applicant.

Severability: If any provision of this application or any warrant issued pursuant to it is held invalid, the remainder of the application and the warrant shall remain in full force and effect to the extent consistent with law.

Notices: All notices and communications concerning the collection, testing, and storage of specimens shall be made in accordance with applicable legal and evidentiary protocols and provided to the appropriate prosecuting authority and defense counsel as required by law.

Amendments and Waiver: No amendment or waiver of any provision of this application shall be effective unless in writing and signed by both Applicant and the issuing judicial officer where required by law.

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