Indiana statute
Ind. Code § 9-30-6-16 — Bureau certificate; form and contents
Current through 2026 Regular Session
Part of Chapter 6: Implied Consent; Administrative and Evidentiary Matters, Indiana Code.
Full text of Ind. Code § 9-30-6-16
Statutory text current through the 2026 Regular Session. This publication reproduces the official statutory text; it is not the official statutes of the State of Indiana.
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.]
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