Cutler Law Office, P.A.
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First Name:
Last Name:
Email Address:
Street:
City:
State:
Postal Code:
Telephone:
Cellular Phone:
Work phone:
Did you take the BREATH TEST?:
Yes
No
If YES, please tell us about the results.:
Were other tests given?:
Urine
Blood
Other
Did the officer at the time of the stop administer any FIELD SOBRIETY TESTS?:
Yes
No
If YES, please note which tests were given:
Gaze Nystagmus (eye test)
Walk and turn test
One leg stand test
Other
If OTHER, please describe:
Which Law Enforcement Agency stopped you?:
Idaho State Police
Sheriff
City Officer
Other
Please provide a brief description of what happened including the reason the officer stopped you and other details that you believe are important:
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