Ind. Code § 9-30-6-16
Bureau certificate; form and contents
As added by P.L.2-1991, SEC.18. Amended by P.L.2-2005, SEC.40.
The bureau certificate must contain the following information and may be substantially in the following form:
| BUREAU OF MOTOR VEHICLES | ||||
|---|---|---|---|---|
| CERTIFICATE | ||||
| Date of Arrest | Time | Driver's License No. | License State | |
| a.m. | ||||
| / / | p.m. | |||
| Name: (first) | (M.I.) | (last) | Date of Birth | |
| / / | ||||
CURRENT Address (street, city, state, zip)
| Court Code | Cause Number | Sex | Weight | Height | Eyes | Hair |
|---|
| The above motorist | BUREAU USE ONLY |
|---|---|
| REFUSED alcohol test | |
| FAILED alcohol test 0.% | |
| Court Determination |
It has been determined there was probable cause the defendant violated IC 9-30-5 this ___________ day of ________________, 20__ and that charges are pending herein.
| _____________________ Court | ______________________ County |
|---|---|
| ____________________________ | |
| Judge's Signature |
[Pre-1991 Recodification Citation: 9-11-4-16.]
As added by P.L.2-1991, SEC.18. Amended by P.L.2-2005, SEC.40.