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Jason Earnest Attorney at Law
330 South Third Street, Suite 1070
Las Vegas, NV 89101
Phone: 888-834-7523

Do you have any previous drunk driving convictions?

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No

If yes how many?

Were you involved in an accident?

Yes
No

If yes was anyone hurt?

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No

Were any of the following field sobriety tests performed (check all that apply)?

Breathalizer
Alphabet
Counting
Balance
Nose

Were you arrested at the scene?

Yes
No

eg. xxx-xxx-xxxx

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