Sec. 16. 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.
Structure Indiana Code
Article 30. General Penalty Provisions
Chapter 6. Implied Consent; Administrative and Evidentiary Matters
9-30-6-1. Chemical Test for Intoxication; Implied Consent
9-30-6-2. Probable Cause; Offer of Test; Alternative Tests; Requirement to Submit
9-30-6-3. Arrest; Probable Cause; Evidence of Intoxication; Refusal to Submit to Test; Admissibility
9-30-6-4.3. Seized Vehicles; Registration of Certain Vehicles Prohibited
9-30-6-8. Probable Cause; Suspension of Driving Privileges; Ignition Interlock Device; Violation
9-30-6-8.5. Ignition Interlock Device; Notice
9-30-6-9. Suspension of Driving Privileges; Duties of Bureau
9-30-6-12. Suspended Driving Privileges; Proof of Future Financial Responsibility
9-30-6-13.5. Removal of Suspension From Record
9-30-6-14. Certified Copies of Driving and Court Records as Prima Facie Evidence
9-30-6-15. Evidence of Blood Alcohol Content Shown by Chemical Tests Admissible
9-30-6-16. Bureau Certificate; Form and Contents