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| Question | Answer |
|---|---|
| Form Name | Dic 23 Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | dic forms, dic 23 form, dic 24 spanish audio, dic 23 instructions |
PEACE OFFICER’S SWORN REPORT
STATE OF TEXAS
COUNTY OF
Before me, the undersigned authority, on this day personally appeared |
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known to me to be |
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a credible person, who, having been by me duly sworn, deposed as follows: |
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My name is |
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, and I am a Texas Peace Officer. I certify that the following information is |
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true and correct: I had probable cause to believe and do believe that |
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Subject’s Name |
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was driving or in actual physical control of a motor vehicle in a public place, or watercraft powered by an engine having a manufacturer’s rating of
50 horsepower or above, in this state while intoxicated or under theinfluence of alcohol. Facts in support of this belief are: A. Contained in report(s) incorporated by reference for all purposes as ifwritten and copied herein.
Specify report(s) or document(s) |
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No. of pages |
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OR |
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B. Noted in the following: |
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I. On or about |
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, was observed by |
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DateandTimeofOffense |
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DescriptionofMotorVehicleorWatercraft |
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Observer |
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in the following public place |
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Location(address,includingcityandcounty) |
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II.Reasonable suspicion to stop or make contact:
III.The driver was identified to me as
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Name |
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DriverLicenseNo. |
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IV. Probable cause for arrest or detention: |
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a. Signs of intoxication or consumption of alcohol: |
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b. Sobriety tasks requested, if any, and performance obtained (explain): |
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I |
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am not certified to administer standardized field sobriety tests, |
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not including horizontal gaze nystagmus |
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continuation page(s) incorporated by reference for all purposes as if written and copied herein.
V. Check one: |
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Subject provided specimen - Intoxilyzer results: |
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Subject refused test |
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Subject provided blood sample, results pending |
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Subject was a minor and was not requested to provide a specimen
Thestatutorywarninggiventothepersonissetoutindetail
FOR DEPARTMENT USE ONLY
Officer’sSignature
PrintedName
Agency
SWORNANDSUBSCRIBEDbeforemeonthe[NOTARYSTAMP]
dayof,2
NotaryPublic,StateofTexas