Do you have any prior record in Colorado?

Yes
No

Please list the current charges against you:

What was the date of alleged violation(s)?

Were you involved in an accident?

Yes,
No

If yes was anyone hurt?

Yes,
No

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

Portable Breathalyzer
Alphabet
Counting
Heel-to-Toe
One Foot Stand

Were you asked to take an official breath or blood test?

Breath Test
Blood Test

Please describe your situation:

Were you released without posting a bond?

Yes
No, I had to post a bond

What Court (County) do you need to appear in?

What is your appearance date?

What police agency were you arrested by?

Colorado State Patrol
Local County Sheriff
Local City Police

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