David G. Crum & Associates, P.C. - Online DWI Case Evaluation

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DWI Evaluation

WARNING: if your breath or blood test was above .08 or if you refused to take a breath or blood test, you are facing an administrative revocation of your driver’s license. You have only 10 days from the date of your arrest to request an administrative hearing regarding the loss of your license, or your license will automatically be revoked. Our firm can assist you in requesting an administrative hearing, call us immediately at (505) 843-7303. Please do not provide telephone numbers for locations at which you do not want to be contacted.

Personal Information

First Name

Last Name

Home Phone

Work Phone

Other Phone

Email Address

How did you find us?

How did you find us (other)?

What's the Best Time to Contact You: am pm

Where Would You Like to be Contacted: Home Work Other

Case Information

Date of Arrest

Upcoming Court Dates

Arresting Officer

Judge's Name

Court your case is in

Court Time

Why were you stopped by the police? (Check all that apply)

	Speeding		Accident		Ran a red light		Ran a stop sign
	Improper Lane Change		Weaving		Roadblock		Other

Did you submit to a breath, blood or urine test? Yes No Don't know

What were the results of the breath test (if you took one)? First breath sample Second breath sample

Did the officer read you the implied consent warnings (these warning are usually read from a card, telling you that if you don't take the breath, blood or urine test, that you will lose your license)?
Yes No Don't know

Did you take any field sobriety tests? Yes No Don't know

If yes, which tests? (check all that apply)

Recite the ABCs	Follow a finger or pen with your eyes
Walk on a line, turn, and walk back	Stand on one leg and count
Other (please specify):

Have you been arrested and convicted of DUI within the last five years? Yes No

Have you been arrested and convicted of DUI anytime in your life? Yes No

Have you ever been arrested [other than for moving violations (traffic tickets)] Yes No

Additional Comments:

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as they are on the background (case-sensitive).

With Offices in Two Locations:
Crum & Associates 1005 Marquette Avenue NW Albuquerque, NM 87102	Crum & Associates 4351 Jager Rio Rancho, NM 87124