FILED: 10/22/2020 2:12 PM

John J. Griffin Vermont Superior Court

DEFENDANT: ARRAIGNMENT DATE: October 26. 2020 Windsor Unit
DO[3: 07/12/1977 AGE: 43 20-15983
SA CASE II).: 20-CR-02466
ADDRESS:
ASSIGNED (D)SA: Emily Zukauskas i:
126 Grouse Lane
POLICE DEPT VSP-Rutland
Ludlow, VT 05149 INVESFIGAIING OFFICER: Trooper Katrina Ducharme
VICTIM ADVOCATE:
INCIDENT NO.: 20B403 966
STATE OF VERMONT

SUPERIOR COURT
WINDSOR UNIT

STATE OF VERMONT CRIMINAL DIVISION

V. DOCKET NO.
JOHN J. GRIFFIN

INFORMATION BY STATE'S ATTORNEY

By the authority of the State of Vermont, the State's Attorney for Windsor County, upon the oath of
office charges:

COUNT 1 OF 2

CHARGE CODE: 23V1201A2#1 CODE ID: 894 I OFFENSE CLASS: M

CHARGE NAME: DUI #1-INFLUENCE

John J. Griffin. in the County of Windsor, at Plymouth on or about October 11, 2020, operated a motor vehicle
on a public highway while under the influence of alcohol, in violation of 23 V.S.A. § 1201(a)(2).

Penalty: Imprisoned not more than two years or fined not more than $750.00 or both.

COUNT 2 OF 2

CHARGE CODE: 23V1091A CODE ID: 862 OFFENSE CLASS: M

CHARGE NAME: VEHICLE OPERATION-CARELESS OR NEGLIGENT

John J. Griffin, in the County of Windsor, at Plymouth on or about October 11, 2020, operated a motor vehicle
on a public highway in a negligent manner, in violation of 23 V.S.A. §1091(a).

Penalty: Imprisoned not more than one year or fined not more than $1,000.00 or both.

Against the peace and dignity of the State.

DATED: October 22, 2020

State's torne (Desuty)

Referral(s) if applicable: No Diversion Referral - Predicate Offense

This information has been presented to me and I have found probable cause.

DATED: 10/22/2020
aéwi D.
‘7?
Superior Court Judge

Offer: TBD

Conditions; 1,2, :7, 31 —WindsorLADC

UCI, LU LVLV z: D Ut iana YL)l lllfl ..O. f,L V.

DUI SUBJECT TEST

STATE OF VERMONT

DataMaster DMT: 100155

Location: RUTLAND VSP
Certification Date; 03/15/2017
Installation Date: 03/17/2017
Date; 10/11/2020
Time: 20:18:29
SUBJECT NAME:
JOHN J GRIFFIN
DOE: 07/12/1977 AGE: 43
GENDER: M
LICENSE #: 078910509 VT
CASE #: 20B403966
TIME OF INCIDENT: 10:00
LOCATION OF INCIDENT;
VTRT100
TOWN: PLYMOUTH
COUNTY: WINDSOR
TE5 OIWICER NAME:
FATRINA R .DUCHARME
AGMCYz RUTLAND VSP
Obs. Period Start: 20:03
BLANR TEST 0.000 20:19
CAI]'RhTToN CI4ECR PASSED 20:19
sXMTJLA.TOR VAPOR 34.0C C 0.098 20:19
BLANK TsT 000O 20:20
SUBJECT SAMPLE REFUSED 20.; 20
Subject refused.
Reason: SAID NO

All alcohol values reported in g/2101

Sirn. Vapor Concentration 0.101
Sirn. Vapor Range 0.096 - 0.106
Lot #: 2005100

DMT goriI Numbc #100i55 Pe I of I 10/11/2020 8:21 FM

 STATE OF VERMONT
DEPARTMENT OF PUBLIC SAFETY TEL: 802•244•8758
VERMONT FORENSIC LABORATORY FAX: 802•241•5557
45 STATE DRIVE E-MAIL:DPS.ForensicLabvermont.gov
P.O. BOX 47 http://vfl.vermont.gov
WATERBURY, VERMONT O56760047

NOW COMES Amanda Bolduc, affiant, being duly sworn and on oath, deposes and says:

1) 1 am a Senior Forensic Chemist employed by the Vermont Forensic Laboratory as the Toxicology Section Supervisor.
This position oversees breath and blood testing for ethyl alcohol, subsequently referred to as alcohol.

2) 1 have been recognized in the courts of the state of Vermont as an expert in the fields of analytical chemistry, the
theory, operation and use of the DM1, the absorption and elimination of alcohol in the human body, the relating of the
result of the analytical process to an earlier pcint in time and the effects of alcohol on the human body.

3) I am familiar with the Vermont Department of Public Safety's rules concerning analysis of breath samples for alcohol
content (effective 3/29/13).

4) The evidential breath alcohol testing device in use in Vermont is the DMT, an instrument which employs infrared
absorption as its method of analysis. Through rulemaking, the principle of absorption of infrared energy has been
adopted as an approved method of breath alcohol testing.

5) I have been trained by the manufacturer of the DM1 to operate, calibrate, certify, maintain and install these
instruments.

6) The DMT has been tested and approved by the federal government as an evidentiary device. The DMT appears on the
Department of Transportation, National Highway Traffic Safety Administration's list of Conforming Products
published in the Federal Register (Federal Register VoL 82, No. 211, Thursday, November 2, 2017).

7) The Vermont Forensic Laboratory has been assessed by ANSI National Accreditation Board and has met the
requirements of ISOfIEC 17025:2017, ANAB 17025:2017 Forensic Science Testing and Calibration Laboratories
Accreditation Requirements while demonstrating technical competence in the field of Forensic Calibration. Certificate
Number: FC-0015, issued 7/15/2019, valid to 9/30/2023.

8) Through rulemaking perfonnance standards have been established for evidential instrumentation. The DMT meets the
performance standards because:

A) The DMT is capable of accepting and analyzing a subject's expired alveolar, or deep lung, air (breath).

B) The DMT is capable of analyzing replicate samples containing a known concentration of alcohol with a
precision of plus or minus 5% from their mean when alcohol concentrations are reported to three
significant figures. The DMT reports results as the number of grams of alcohol per 210 liter of breath
(g/210L).

C) The DMT meets and exceeds the minimum test accuracy required by rule for alcohol testing of plus or
minus 10% or 0.005 g/2l0L, whichever is greater, when analyzing a simulated breath sample of a known
concentration, when alcohol concentrations are reported to three significant figures. This demonstrated
capability directly extends to accurately evaluating a breath sample.

D) The DMT is capable of detecting the presence of compounds in breath which could potentially interfere
with the accurate determination of a breath alcohol concentration.

DM7' Generic ZR Affidavit

Effective Date 01102020
Page 1 of 2
 E) The DMT and the methods used for determination of breath alcohol concentration for evidential purposes
have been approved by the Commissioner of Public Safety (effective 9/3/20 19).

9) Based upon testing performed within and outside the state of Vermont, my knowledge of the scientific literature
regarding breath alcohol testing, and my training and experience with the instrument, it is my opinion that the DM1 is
an accurate and reliable instrument for determining the alcohol concentration in a sample of a person's breath.

10) The DMT provides a reliable and accurate means for analysis of breath alcohol samples. The software on the DMT is
designed as a fail-safe; in order to proceed with a subject test and report an ethanol result, the instrument must meet all
internal and external quality control checks. The reporting of an alcohol concentration of a person's breath by the
DMT is evidence that the instrument successfully met the performance standards contained in the rules at the time the
breath sample was analyzed.

11) A DMT result obtained by an officer certified to operate the instrument and when taken in accordance with the
procedures incorporated in the Vermont Criminal Justice Training Counsel Student Manual in effect at the time of
testing and approved by the Commissioner of Public Safety is accurate and reliable and is in compliance with the
provisions of the Department of Public Safety'srules.

Dated at Waterbury in the county of Washington, Vermont this 10th day of January 2020.

Amanda Bolduc, MFS

Afflant

Subscribed to and sworn before me at Waterbury, Vermont on this

Notary Public

Commission Expires: / 2I

DMT Generic JR Affidavit

Effective Date 01102020
Page 2 of 2
 (I I\u I an mi n O 19L

DCI AFF[DAVIT IAI1) ?age 1 of 4 Revised April 2020

CASJL# 2o(34 ,q
NOW COMES tb. 1D ,affiant being duly sworn and on oath, deposes and states that I have probable
cause to believe that C. , hereinafter referred o as operator and defendant, committed
the offense of Driving Under the Influence in violation of 23 V.S.A. § 1201. In support ofhis charge the afflant states:
1. I ani a law enforcement officer certified by the Vermont Crimlnal Thstice Training Council. I am trained and certified by the
Vermont Criminal Justice Training Council to operate the DMT infrared breath-testing instrument.

2. On diIqr Ij 1oac. at '1 Dx - hours, the defendant was operating/attempting to operate/in actual
physical control, of a (year/make/model) .øZO, Stv'rtc)o , bearing registration 'D 0
on a public highway known as V1 4- I Oc in the toWJcity of in the county
of Lii "J5nr in the State of Vermont.

3. A. My observations of the defendant's operation that resulted in my rnaldng this stop are documented on Page 1-A.

0RB Although I did not observe operation iii this case, I was able to determine that the defendant operated the above
described vehicle at I€'7'V hours based upon the evidence presented on Page 1-A of this affidavit.
(If offiee did NOT observe the driving, su.b,nit with case statements from witnesses establishing that this accused
drove the ehicle, the approximate TIME. and the public highway.)

4. OBSERVATION OF OPERATOR
Odor of lntoricants UStrong l,foderat ElFaint DNone
Eyes Vatery UBloodshot flWonna[
Speech jJUriintelliible [j]Mumbled [1S!wrcd LiConfused Nortna[ 6'vw4 fLses
1. Have you consumed any alcoholic beverages? IF OF?XCBR DID NOT OBSERVE THE OPERATlOI' (Whethei crash.or.not) ASK:
Jo [j]Yes: How many?
2. What time was your first drink? itJ 41 Did you drink any alcoholic beverages after driving I Yes: How many?
3. What time was your last,drink? How )rniCb did yon drink in the 30 minutes before you stopped driving?

4. How much, if anything, have you had to drink in the last 30 minutes?
5. Have you consumed any drugs or medications? jNo LjjYes: What?
6. Other observations (e.g. alphabet, counting, etc.): tSeAk ft c)cdeS /)vSJi4(/ Lf

7. IJifficulty getting out of vehicle? ]No [j]Yes: Describe:

Standing — DPailing [jExtreme Sway [ISlight Sway LiUnsteady Steady
Wsfldng OFalling DSrumtding []Unsteady flSteady
Alcoholic containers in vehicle? []No ies # . T,pes: (Ji1J ftes LiFull mpty DNo
p. L1eMf2'e il1
k# g5, . sa GO($

5. STAN)ARDIZfl) FIELD SOBRIETV TESTS

Is there any reason that the operator cannot perform these exercises? o flYes: Explanation (e.g. roady, health, etc.):

L.EYE R.EYE ii' be r,iic/at pteJ- lv fwove i4d

'1Lacl of smootb pursuit ILacJ /1' r&"o fat o ,pJz& p'
HGN Distinctjerkinea3 at maximum deviation
IOnsct of distinotjerkiness prior to 45' Total Clues
...1.....LLU.L2L15
L USISLL - .. ....... LLIöLL UULLUSL
5nrts before instructed
f Lilneorrect njnnb of steps ekp •
Walk Stops walking to steady sclf rC4'.m 4 ttoes not touch heel In toe LICannot do exerciSe J4ee .fei,.rfi.d
& Turn LosesbalanceJteps off line flUsca arms for balance (steps off line 3 times)
..oscs balance while turniagcoi 1 Total Clues
One JSways while balancing flHopping L-'J€2 ) '
I t\ p.4- 1- ôou'i .T/AXd 14C tsh'44-
Leg ElCannot do eercisc (pots foot down 3tiines) ?uts foot down M ('(. -'. +6 -.
Stand arms to balance (raises arms arnie than 6 inches) ,_ Total Clues rsk 4' eY f ,o/ P&
Comnnts s_-, 21'/4-4J lk4t, Dt, (ii fU4 ktI/Q&i.(

qsi To be complefe'cI by - ModifIed Ithmb erg

I
ABIDE or DRE
trained Officers only Internal Clock

Right eve Left eve En. s 30 5CGOn4s

Officer's opinion ofImpairnie.á
[]None jSlight 1oderáte []Substantial [I]xtreme
PBT Resnit BAC at - His. Model: Serial #
 L.U. LL IL;vr L idfl. V /111fl D.

AFFIDAVIT
Vermont State Police
Rutland Barracks

VERMONT SUPERIOR COURT -CRIMINAL DIVISION

STATE OF VERMONT
RUTLAND COUNT

Now cos Trooper Katrina R. Ducharme being duly sworn and on oath, deposes and says she
has probable cause to believe that John I Griffin (DOB; J7/12I77 has committed the offense(s) of
Driving While Under the Influence #1 a violation of Title 23 V.S.A. § 1201.

1.) I am a Vermont State Trooper, currently assigned to the Rutland Barracks as a uniformed Trooper. I

am a full-time certified law enforcement officer in the State of Vermont, having been certified by the

Vermont CriminaJ Justice Training Council since May of 2015. I am a certified Drug Recognition Expert in

the State of Vermont and have been since September of 2018.

2.) On October 11, 2020, at approximately 1800 hours, I was dispatched to a two-vehicle motor vehicle

crash on Vermont Route 100 in the Town of Plymouth, VT. Upon my arrival, I observed two vehicles on

the shoulder of the roadway with debris from the crash in the roadway. The operator of vehicle #1, was

present on scene and identified himself with his Connecticut driver's license as, John J. Griffin (DOB:

07/12/77). The operator of vehicle #2 was present and identified herself with her Massachusetts photo

driver's license as, Marta Grala (DUB: 03/13/86). While speaking with (3ra1a her passenger, Mardy Simon

(DOB: 05/02/87), informed me he believed the operator of the other vehicle was intoxicated. I asked Simon

why he believed that and he stated that when he was helping him tear off the front bumper of their vehicle,

he could smell the alcohol coming off his breath.

3.) Girala informed me she was traveling south on Vermont Route 100 when she went to turn left to get

turned around. Grala stated the vehicle traveling'behind her went to pass her on the left as she was turning

left and subsequently struck her vehicle on the driver side. Grala stated the operator had offered her cash

20B4039661 Page 1 of 3
 UCL LU. ZULU IL: UL land vul furnln ). iL'J H i

AFFIDAVIT
Vermont State IoIice
Rutland Barracks

VERMONT SUPERIOR COURT -CRIMINAL DIVISION

and a check to not call the police

4.) I spoke with Griffin who informed me he was traveling behind another vehicle on Vermont Route

100. The vehicle moved towards the shoulder of the road and so he was going to pass it on the left. The

vehicle in front of him then turned left in front of him. Griffin stated he was very sony for what happened

but, he had given him all his information for the crash. While speaking with Griffin I observed his eyes to

be watery. I further detected a moderate odor of intoxicants emanating from his person. I asked Griffin if he

had consumed any alcohol tonight and he stated no. Griffin was adamant that lie was not intoxicated. I

asked Griffin if he would be willing to perform Standardized Field Sobriety Tests (SFSTs) and he stated he

would. I asked Griffin if he had consumed any alcohol 30 minutes prior to crashing or post crash. Griffin

stated he had nothing to drink, I asked Griffin if he had any medical problems that would prevent him from

completing the tests and he stated no. Griffm stated he was cold and shivering. Griffin further stated to me,

jf I felt he was unsafe to drive, I could follow him home to Ludlow. I told Griffin that I would not be doing

that.

5.) During the horizontal gaze nystagmus Griffin had to be reminded several times to keep his head

still. Lack of smooth pursuit was redone because of his head movements at the end of the other SPSTs.

During the Walk and Turn, Griffin couldn't balance during the instructional stage and started before

instructed Griffin stepped on his first foot. Griffin restarted the test on his own, Griffin turned incorrectly,

stepped off line, and stopped walking to steady himself, During the One Leg Stand, Griffin lifted his leg,

started, and then put it back down saying he wasn't ready yet. Griffin took a long time to restart the test.

Griffin complained about the gravel under his feet. Griffin used his arms for balance when he put his foot

down at count #1014. I conducted additional ARIDE tests and noted the results on the DUI affidavit form.

2OB4O3966J Page 2 Qf 3
 LJC L LJ LLILIJ IL R LI kO, f;'L: r.

AIFFIflAVIT
Vermont State Police
Rutland Barracks

VERMONT STJPERIOR COURT -CTuMrNAL DIVISION

That form is attached and incorporated into this affidavit as if fully set forth herein. Based on the results of

Griffin's SFSTs he was taken into custody and transported to the Rutland State Police Barracks for

processing.

6.) While at the Rutland Barracks, I read Griffin his Miranda rights, in which, he waived. Griffin stated

that he would talk with me but was adamant that he had not had anything to drink. While at the Rutland

Barracks, Griffin was read implied consent. Griffin refused the infrared device and provided no breath

sample. Griffin was issued a citation to appear in, Vermont Superior Court, Rutland Criminal Division, on

October 26, 2020 to answer to the charge of DUI #1.

Sworn to me bef.r this , fay of October, 2020

(Notary) (Affiant)

20B4039661 Page 3 of 3
 LJC L LJ LLILIJ IL R LI kO, f;'L: r.

AIFFIflAVIT
Vermont State Police
Rutland Barracks

VERMONT STJPERIOR COURT -CTuMrNAL DIVISION

That form is attached and incorporated into this affidavit as if fully set forth herein. Based on the results of

Griffin's SFSTs he was taken into custody and transported to the Rutland State Police Barracks for

processing.

6.) While at the Rutland Barracks, I read Griffin his Miranda rights, in which, he waived. Griffin stated

that he would talk with me but was adamant that he had not had anything to drink. While at the Rutland

Barracks, Griffin was read implied consent. Griffin refused the infrared device and provided no breath

sample. Griffin was issued a citation to appear in, Vermont Superior Court, Rutland Criminal Division, on

October 26, 2020 to answer to the charge of DUI #1.

Sworn to me bef.r this , fay of October, 2020

(Notary) (Affiant)

20B4039661 Page 3 of 3
 'JCI.L,LJ/U .L:/iI,, utIan Vu dnin No. /YL) .. II

DTJI AEFJ]AVIT — INFRARED Page3of4 RevisedApril2b20

.8. IMPLIED CONSWf (Chenk as read).

I am. a law enforcement officer of the State of Vermont.
j4Y I have grounds to believe thatyou have operated, attempted to operate, or been in actual physical contiol of a
vehicle on a public highway while under the influence of intoxIcating liquor, or drugs, or both.
(FATAL/SERIOUS INJURY ONLY) I have probable cause to believe that you are the surviving operator of a motor
El vehicle involved in an accident or collision resulting in death or serious bodily injury to another person. I have reasonable
grounds to believe that you have some amount of alcohol or other drug in your system.

Vermont law authorizes ine, as a law enforcement officer, to iequest an evidentialy test to determine whether you are under the
influence of alcohol or other drugs. Befoi-e you decide, I will explain your rights.
If you submit to an evidentiary test, you have the right to have additional tests administered at your own expense by someone of
your own choosing. The results will be sent only to you or your lawyer. At this titae, I ant also providing you with, a list of
facilities in this area that are available to you for drawing a sample of your blood.
In addiUon, Ifkou submit to an evidexttiary test administered with an infrared device, following your receipt of the results of that
, test, you have a right to a second evideniary test administered by me using the infrared device.
IJ If the results of the evidentiary test indicate that you are under the influence of alcohol, you will be subject to criminal charges
, and your license or privilege to operate a motor vehicle will be suspended for at least 90 days.
If you refuse to provide an evidentiary test, and if you have been previously convicted of Driving lmudei- the
Influence of intoxicants (Dtll,DWI) in Vermont under Title 23 V.S.A. Section 1201 or in any other junsdiction which prohibited
operating, attempting to operate, or being in actual physical control df'a motor vehicle on a highway while under the influence of
intoxicating liquor or drugs, ol- both. or while having .08 percent or more by weight of alcohol in the person's blood or an alcohol
concentration of .08 or more, you may be charged with the crime of criminal refusal..
If you refuse to provide an evidentiaiy test and you have been involved in an accident/collision resulting in serious bodily injury
or death of another, you may be charged with the crime of criminal refusal.
If you refuse to provide an evidentiaxy breath test, your refusal may be offered into evidence against you at trial.
(FATAL/SEfflOUS INJURY ONLY) If you refoe to provide an evidentiary teat and you have been involved in an
El, accident/collision resulting in serious bodily injury or death to another, the court may issue a search warrant and order you to submit
to a blood test; Your refusal to submit to an evidentiary breath Lest may be offered into evidence against you at trial, whether or not a
search warrant is iought, and the results of any blood test ordered by the court may be offered into evidence against you at trial.

Your privilege to drive shall be suspeniled for at least six months if you refuse the evidntiary test and the court finds my request
is reasonable.
You have the dght to taik with a lawyer before deciding whether or not to submit to an evidentIsxy test. If you want a lawyer, a
Public Defender will be contacted for you at the state's expense, regardless of your income, or an attempt will be made to contact
an attorney of your choice at your expense. S
You must decide whether or not to submit to the evidentiary test within a reasonable amount of tune and rio later than
30 minutes from. the time of the initial attempt to contact an attorney, regardless of whether a consultation takes place,
' Do you understand each of these rights? Yes ElNo
Do you want to talk to a lawyer before deciding whether or nOt to submit to a test'?
El Yes Time of first attempt: (per timepiece) # of attempts
Lawye. co . e.- Time Started: Time Finished:
'No

Witness
(If operator refuses &rign you MUST contact an attorney' unless a recorded waiver is obtained)
Will you give a sample of your breath as evidence El Ys [No. (IF "No," OPIC1 SHOULD GO TO Sec. 10)
IF YES, 15 Mm OBSERVATION PETllOI started at: hours Timepiece used:
C1 The operator has been observed for 15 unInterrupted minutes during which he/she did not burp, belch, or vomit.
LI Operator was asked: Have you burped, belched, or vomited withIn the last 15 minutes? Elyas ElNo
If Yes, restart 15 mm. observation. Lesfarted atr . hrs. (per timepieca)
El 'Your result is % at per DMT clock AND (per timepiece)
date .
If result is "INVALID", ffieer should rerun evidentiary test by replacing mouthpiece, then RESTARTING NEW 15 MINI
OESERVATION period. Restarted at lirs. (per DMT Clock)
El Your result is % at per DMT clock AND (per timepiece)
date .
El )Do you want a second infrared test NOW? El Yes L No
I administered the operator's DMT breath teSt in accordance with my training and certification.
The evidèntiaiy ticket(s) is (are) incorporated by reference into this affidavit.
 UCI. L 1J ZULU iL:dr NUL 5d VV f\driiin

DUI AFFIDAVIT — IARE1) Page 4 of 4 Revised April 2020

9. READ THE APPROPRIATE ALTERNATiVE TO OPERATOR

El A. If operator is beiigjelea,d on their own or to a sober adult: Sinec you are being released, if you wiah.additional teStS, to be
paid for at your own expense, you will have t, make your own arrangements.
Do you intend to obtain additional tests? EI1Yes LINo Test I(it Provided ElYesL1 No

If, at the completion of processing, the operator, after reasonable efforts, is unable to arrange transportation necessary to
obtain an additional test and the operator varits a test, the officer must arrange to provide transportation to a facility that
will administer the test.
fl P If operator is beinLtaken to detox or held for an extended period of time: ecause you are being detained for a short period
prior to being released, I will make arrangements for you to have an additional test, at your expense, if you so desire
Do you want me to transport you to obtain an additional test? DYes ElNo
Test Kit Provided DYes ONo Arrangements:
El C. If operator is being lodged: Because you are being lodged, you must.teU me now if you want an additionaltest, at ycwr
expense, so that I can make the anangerrients. Do you want me to transport you to obtain an additional test? [JYes ElNo

10. STATUS OF OPERATOR:

'Inquired as to the operator's current address and informed him/her that information is required for ñitui-e mailings
Mailing Address (Zj... ____ Residential Address (&
It1otj
Is operator on active duty, or scheduled to go on active duty, in the Armed Foi-ces? [I]Yes No — If yes, Command
Unit, Service Branch, and Service #
Cr'
Operator identified by Iiccnse Q7$ if It [jOtber ID. . [I]Picture I.D.
DCitation LI]Lodged LPeleased without Citation LiComplaint # ElOther

11. DISCLOSURE OF EVIDENCE:

A. 0FF10ER'S OBSERVATIONS OF OPERATOR
Attitude LIIExcited talkative []Indifferent [I]?rofane []Cmbative
Insulting []Cocky operatiVe olite []Mood Swings
Other: 5%M- Pcic
Unusual Actions: LllHiccuppin.g Beliiig LiVomniting [II]ighcitig Laughing
B. MOTOR VEfflCLE RECORD & DUI CONVICTIONS
The DMV RECORD of Operator is attached and incorporated by reference as if folly set forth ierein.
Record discloses prior DUI Convictions: EYes: dates of prior DUX conviction(s):
C. CORDING Is there a separate audiotape? []Yes o
'Video: Cruiser4 es LINo DIJI Processing Room 'es []No []Other:
I). WITNESSES (Passengers / other persons) S
Namb: Address:
Phone# LjPassenger EjOther Describe Condition:
Statement obtained: [II]Yes LINo
'Other witnesses J1sed on separate page

12. DISPOSITION:
OperatOr released Name/Address:
to: Phone #: ___________
OR.. Operator taken to: (,p-cr Oz-'S Phone #:
Acknowledged operator is impaired LINe DYes: [liSlight []Extreme [I.Other: 4J
Signature: itj £qiik'v 06k1kie.1/ ' e Orcee 1Iuvr.. tiié
Date & Time processing completed: jo / /! I - o per timepiece.
Disposition of operator's vehicle: 'ThS Condition of operator's vehicle: f" /u "4." Cl-s-
yiN of operator's vehicle: CV8L t c' 9/ 3
Name of Registered Owner(s): r. Address: J? &rz-'.a /an (AL
Being duly sworn and oath, I hereby certify that the information contained this
on in formhan been accurately recorded and accurately
describes my observations of the actions ajid statements of the operator identified on page one.

Signature

Subscribed and sworn before me this / day of

 utI ana YL) fllfl D. fiL H

Form 240 NOTICE O. :NTION TO SUSPEND AND/OR DISQU' —. FY

rnuv ICENSE OR PRiVILEGE TO OPERAT, .,
(pursuant to Sectió 205, 1218 and/or 4116 of Title 23 of the VermoDttutes)

IA! J. UI VEKIVIUN .1 lncentNo.

SUPERIOR COURT C11MfNAL DIVISION - 20.13tf 0
Uru Department Date of inoident Time
AM
or . iiv SL £ Ia/i 1'I2j Dri,ers License No.
t'V
Slate
Name
. :J - q/ g -sq. C-'T
Mailing Addreas CDL? Oiiving a Cominercial Vehicle? Hazardoua Materials?

/ '1- . ( 0 Li /PI IllYea ill Yes o

Town/City Stare Zip Cadc Social Se.uritv N,tnThe.r ItS DOT S
/€J/O --
Age , Dale otOirtli Plac oFairth Tokphano Number(s)

4 /12._i, ? /ikw c+ -k ô.h4• Home

1lis is your first violation of 23 V.S.A. section 1201: Effective date ofsuspension is set forth below unless a hearing is requested.
— This is your 2nd or subsequent violation of 23 V.S.A. section 1201 or 2nd or subsequent suspension under 23 V.S.A. section 1205
after July 1, 1991: Effective date of suspension is St forth below, even if you request a hearing.
You operated a motor vehicle with a blood alcohol concentration (BAC) of 0.02% or niore after previous conviction within the
receding three years with a BAC for the second or subsequent was proven to be 0.16% or greater pursuant to 23 VSA. 120 I(d)(2).
You refused to submit to the breath or blood test (license suspension of at least six months).
The results of the breath or blood test show that your alcohol concentration was or more, equal to or more than 0.08%, or
0.02% if operating a school bus or after previous conviction of 0.16% or greater (license suspension of at least 90 days).
You operated a commercial vehicle and refused to submit to the breath or blood test.
You operated a commercial vehicle and submitted to a breath or blood test which shows your alcohol concentration was or
more while operating a conirnercial vehicle, equal to more than 0.04%.
THEREFORE, the Commissioner of Motor Vehicles will be notified to:
USPEND your driver's license or privilege to operate a motor vehicle.
DISQUALIFY you as a commercial driver for a period of at least one year (if first offónse) or for your lifetime (if this is your
second or subsequent offense) and until all requirements are met for license reinstatement.
UNLESS YOU REQUEST A HEARING to argue that your license should not be suspended or disqualified, YOUR DRiVER'S
LICENSE. COMMERCIAL DRIVER'S LICENSE AND/OR YOUR PRIVILEGE TO Q7PERATE A MOTOR VEHICLE IS
SUSPENDED AND/OR DISQUALIFIED BEGINNING: Date Suspension andior Disqualification Begins

/4z. 7
-/2

•IF THIS IS YOUR FIRST VIOLATION OF 23 VS.A, SECTION 1201 AND YOU DO NOT REQUEST A HEARING, YOUR LICENSE
WILL BE SUSPENDED AS PROVIDED IN THIS NOTICE. IF AFTER JULY 1, 1991, YOU WEkE CONVICTED OF A VIOLATION OF
23 V.SA, SECTION 1201 OR HAD YOUR LICENSE SUSPENDED PURSUANT TO 23 V.S.A. SECTION 1205, YOUR LICENSE WILL BE
SUSPENDED ON THE 11TH DAY AFT1tR YOU UtCE1VE THIS NOTICE, WhETHER OR NOT YOU REQUEST A HEARING. IT IS A
CRIME TO OPERATE, ATTEMPT TO OPERATE OR BE IN ACTUAL PHYSiCAL CONTROL OF A VEHICLE WHILE YOUR
PRIVILEGE TO OPEHATE IS SUSPENDED.
1) YOU HAVE THE RIGHT TO ASK FOR A HEARING BEFORE THE COURT TO CONTEST THE SUSPENSION
AND/OR DISQUALIFICATION OF YOUR OPERATOR'S LICENSE. IF JUDGMENT IS ENTERED AGAINST YOU IN THIS
PROCEEDING, YOU WILL 13E ASSESSED COURT COSTS OF $90.00
2) If you do not request a hearing, your license will be suspended and/or disqualified as provided in this notice.
3) If you wish to request a hearing before the Court. you must mail or deliver your request for a hearing to the Commissioner of
Motor Vehicles by: Date Request Due
/1) Date Request Due
4) If your rcquest for a hearing is not mailed o delivered to the Commissioner of Motor Vehicles by
you waive your right to a hearing and your license will be suspended and/or disqualified as provided in this notice.
5) In order to request a hearing, sign the section of this form and mail or deliver the form to the Commissioner of Motor Vehicles at 120 State
Street, Montpelier, VT 05603,
6)1
Circuit/County Court Addceaa . Date lime AM
o •
u ai
Lw11L- ( J.1 &-c-
(Thislhearing will bescheduled to take plac'within dys from the date of the offense.)
Date Issued
This notice waa"iand delivered LII mailed to the operator on

An affidavit describing the reasons the breath test was requested by the officer: jJ was given or mailed to the defendant with this notice.
wil[be mailed at a later date.
Of!i?ame(Pjinted) Oc7Jc Signniure.Lav EnntOfticer

Rv 7/K SMI. Cr,m., 1' m - re..i,"er h.rino Cnnv 7 Onrrernrg R '.crcl.c- (Thnv : flr.nArtmCnt nt'Mrenr Vehicles: CoDy 4 Offir