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DUI Form
admin
2016-12-05T22:55:46+00:00
Do you have pending DUI charges?
Select One
Yes
No
Not Sure
What is your zip code?
Prior alcohol related offenses
Select One
Yes
No
Type of alcohol test performed
Select One
No Test
Refused Test
Breath Test
Blood Test
Urine Test
Don't Know
Blood alcohol content measured by test
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0.00% - 0.04%
0.05% - 0.08%
0.09% - 0.12%
0.13% - 0.16%
0.17% - 0.20%
More than 0.20%
Don't Know
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