Questionnaire - MA OUI - Mass DWI Attorney - DUI

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OUI Questionnaire

Immediately provide all paperwork you have received from Police or the Court by fax to
978 349 6800
or scan it and email it to joseph@waldbaumlaw.com.

PLEASE COMPLETE EVERY PART OF THIS FORM TO THE BEST OF YOUR ABILITY, AND BE 100% TRUTHFUL IN EVERY RESPONSE. THE SOONER YOU COMPLETE THIS FORM, THE BETTER YOUR MEMORY WILL BE ABOUT THE INCIDENT AND ALL THE IMPORTANT FACTS SURROUNDING YOUR CASE. YOUR DETAILED ANSWERS TO THESE QUESTIONS WILL BE THE PRIMARY SOURCE OF INFORMATION THAT I WILL USE TO CHALLENGE THE STATE'S CASE AGAINST YOU. LACK OF INFORMATION GREATLY IMPEDES MY ABILITY TO DISCOVER WINNING DEFENSES OR JURY ARGUMENTS.

ALL PERSONAL DATA IS ENCRYPTED IN TRANSMISSION AND WILL BE KEPT CONFIDENTIAL. DON'T DELAY IN RETURNING THE QUESTIONNAIRE SINCE TIME CAN BE AN IMPORTANT FACTOR IN YOUR CASE.

If you would rather fill out the form by pen and fax it in, print this page and fax it to (978) 349-6800.

IMPORTANT QUICK REFERENCE DATA

1. Name (first and last):


2. Date of birth:


3. Place of birth:


4. Home Address (including city/state):


5. Home Phone Number:


6. Other Phone Number:


7. Please Call Me At:


8. Social Security Number (no dashes):


9. Your Email Address:


10. Date of Arrest:


11. Time of Arrest:


12. Next Court Appearance Date:


13. OUI Offense (1st, 2nd, etc.) In Your Lifetime:


14. List Other Charges:


15. Court Handling Case (Full Name):


16. Alleged Breath Test Reading:
First:
Second:
Refused:

17. Police Department Involved:

1. BASIC

1. How were you referred to (or how did you learn about) our office:
Friend Lawyer National College of DUI Defense Website DUI1.com / DUI Defenders Website YouTube Avvo Bing/MSN Google Yahoo Other Search Engine: Letter If by letter, did you watch the mini DVD?
What search term did you use to locate Attorney Waldbaum, if any?


2. Did you watch the videos?


Were they helpful?


How so?


3. If you found my site on a smart phone, what type?


Was the site clear and easy to see and navigate on your smart phone?


4. What factors weighed most heavily in your decision to hire attorney Waldbaum?


5. Did you contact any former clients?


By:


If so, what advice did they give you?


6. Family Status (married, single, etc):

7. Does Anyone in Your Household Know?


8. Dependent Children:
How Many:
Names and Ages:

2. LICENSE

1. Driver's License Number:

State Licensed In:

2. List Restrictions on License (If any):


3. Possess a Commercial Driver's License (CDL):

3. EMPLOYMENT

1. Employer:


2. Employer Address:


3. Job Title:


4. How Long:


5. Duties:


6. Prior Employment (past 5 years):


7. How Long at Each Job:


8. Educational Background:
Highest Educational Level Completed:


Name of Institution:


Major or Specialty:


Any Honors:


9. Problems With Present Employment:


10. Vehicle Required for Employment:


11. Would you be fired, restricted in duties, passed over for promotion, or demoted if: (check all that apply)
: Convicted of DUI : Your License is Suspended : Suspended with Work Permit

12. Do You Drive a Company-Owned Vehicle:


13. Does Your Company's Insurance Carrier Insure You:


14. How Many Miles Driven to/from/at Work on a Routine Day:


15. How Many Total Miles Driven Each Week (Business and Personal Miles):


16. Is Public Transportation Readily Available to You:

4. HEALTH

1. Weight at Time of Arrest:


2. Height at Time of Arrest:


3. List Any Current or Past Conditions that Might Affect your Balance or Coordination:


4. List Any Current or Past Problems With your Arms, Legs, Knees, Ankles, or Feet:


5. If so, Please List the Doctors or Hospitals that Provided Your Care (include as much of the address as you know):


6. Any Physical Disabilities or Prior Surgery:


7. List Any Prescribed Medication Taken by you Daily or Periodically:


8. List Any Non-Prescription Medication Taken by you Daily or Periodically:


9. List Any Specific Health Problems:


10. List any Denture or Bridgework you May Have:


11. Do Have any Stomach Disorders Such as Acid Reflux or GERD:

5. EFFECTS OF A POSSIBLE CONVICTION

1. What effect would a conviction have on you personally?


2. Would a conviction affect your marriage (relationship)?


3. In what ways would a DUI conviction or license suspension affect your employment or professional standing? Explain:

6. OTHER ATTORNEYS

1. Prior to coming to me for legal assistance, did you consult with any other attorney(s) about the present OUI case If so, with whom?


2. Have you either hired another attorney or paid a partial fee to another attorney?


3. What advice (regarding a possible plea or about challenging this case) were you given by such other attorney(s)?


4. Do you understand that you are free to follow that attorney's advice (or any other attorney's advice), and that you are in no way bound to use my legal services in your case unless you hire me?

7. EVENTS OF THE DAY OF ARREST

1. During the 24-hour period just prior to your arrest, describe your activities IN GREAT DETAIL from the time you woke up until arrest occurred (list them in chronological order). Tell me who you were with, what you drank, at what time the drinks were consumed, what size drinks you had, etc.


2. With whom did you talk to within the last 3 hours before arrest? Include their Name, Address/Phone, Relationship, Employer.


3. Was anyone with you when you were arrested? If so, please list their name, address, home and work phone:


4. What was his/her condition (sober, drinking, impaired, passed out, etc.)?


5. Did anyone (including the above-named person) observe or overhear any portion or aspect of the police "stop" or arrest? If so, list their names, addresses, and telephone numbers.


6. Did the police allow someone with you to drive the vehicle away from the scene, or to move the vehicle? If "yes", who:


7. If so, give details of what screening for impairment or ability to drive the officer required from this person prior to allowing the person to drive away.


8. Please describe the traffic conditions you encountered on roadways prior to being arrested. Include stop lights (how many and whether they were working properly), caution lights, weather conditions (be specific).


9. Town stopped in:


10. Street stopped on:


11. Nearest crossing street or highway exit:


12. Was arrest at roadblock or license check?


13. How far ahead did you see it?


14. How long did you wait in line before getting to an officer?


15. Were you given any advance notice of the roadblock (i.e., was the roadblock well-marked and visible from flares, fluorescent cones, blue lights, etc.)? If so, give details.


16. How many police cars did you see?


17. Did any have their blue lights on? If so, how many?


18. Did more than one officer give you a field test or interrogate you? If so, how many?


19. How many police officers did you see?

8. DRIVER'S LICENSE AND INITIAL QUESTIONING BY THE OFFICER

1. Any restrictions on your license?


2. If so, were these restrictions being complied with when stopped?


3. Where was your license when you first began looking for it?


4. If you did not have your "plastic" license in your possession at the time of the "stop", give details about where the license was, and why it was not in your possession?


5. What were the officer's first words to you when he/she encountered you? (Be exact)


6. What did you say in response to this question?


7. Did the officer comment on your breath "smelling like alcohol", or similar words?


8. Were any containers of alcohol visible to the officer as he/she observed from outside your vehicle?


9. If so, what type, and were they full and unopened, partially full (seal broken) or empties?


10. Did the officer confiscate these containers, for use as "evidence" against you in this case?


11. Had you "masked" the smell of your breath with food, coffee, gum, candy, breath spray, etc., to cover the smell of alcohol?


12. If so, how or what did you consume or use?


13. Was any other suspicious or illegal item or items (i.e., weapon, rolling papers, bong, marijuana pipe or "roaches") visible from outside your car when the police approached your vehicle?


14. If so, give details:

9. FIELD SOBRIETY TESTS OR ROADSIDE SOBRIETY TESTS

1. Did the officer direct you (or "request" you) to perform any coordination or roadside sobriety tests?


2. Exactly when (how many minutes, seconds after getting out of car) were you first requested to (told to) perform these tests?


3. What was the *exact wording used* by the officer in making this "request or demand"?


4. Did the officer ask you any preliminary questions about your physical limitations or impairments or present illnesses/medications before beginning to "test" you?


5. Before you began doing any of the field sobriety tests (including the hand-held breath tester), were you under the impression that you were "in custody" or "not free to leave"?


6. If "yes", give details why you felt that you were not free to leave:


7. Was there anything about this traffic stop that led you to believe that this was not going to be a "brief" encounter with the police, but that you were going to be detained for a more prolonged period of time?


8. If "yes", give specific facts or reasons for this belief (e.g., took my license, said "you're not going anywhere after this," etc.):


9. If so, what questions did you ask, and how did the officer respond?


10. Describe shoes (if wearing any) during field sobriety tests:


11. Were you wearing shoes for the field sobriety tests?


12. Were there any street lights (or other lights) above or near your location to illuminate the area? Describe the lighting in the area:


13. Before doing any or all of these field tests, did you request to call an attorney?


14. Where were the lights in relation to tests (including automobile headlights)? Give detailed description:


15. What were the agility or coordination tests that you performed in the order given, and how did you do?


16. Road or shoulder conditions where tests were given (check all that apply):
: Level : Sloping : Smooth : Rocky : Wet : Grassy : Dirt : Holes : Ruts : Wide : Narrow : Calm : Line to Walk On : No Line to Walk On : Raining : Snowing : Hot : Cold
17. Glasses:

18. Contact Lenses:

19. Emotions:
: Crying : Nervous : Can't Recall
20. Traffic:

21. Were there any other distractions? If so, please list them:


22. Emergency lights still flashing while tests being conducted?


23. Were there any other people gathered around or watching? If so, how many?


24 If you were asked to recite the alphabet (or part of the alphabet), when was the last time you had said your ABCs before the night/day of arrest?


25. Did the officer say the ABCs through the letter Z before asking you to do it?


26. On any other "verbal" tests that you were asked to perform (such as counting backward), had you ever attempted to do that before being asked to perform on the day/night of your arrest? If so, when?


27. Were you shaking when you were being given the tests?


28. Did the officer demonstrate any or all of the tests before you did them?


29. Did the officer advise you what you had to do on each test to pass it?


30. What compelled you or caused you to attempt to perform these voluntary field sobriety tests?


31. Did the officer ever indicate to you that these agility tests were optional?


32. Did the officer ever make any statement or promise to you that if you passed these tests, that he/she would let you go home?


33. Did the officer ever indicate (*in any manner or fashion*) that by not taking field sobriety tests, that you would be subjected to immediate arrest?


34. Did you ever blow into a hand-held alcohol tester at the scene of the stop?


35. If so, were you permitted to SEE the digital reading that the tester indicated?


36. If so, what was the reading?


37. If not permitted to see it, did the officer tell you the result?


38. What did he/she say about result?


39. Were you asked or required to "blow" more than one test on the hand-held breath machine?


40. Did the officer ever make any statement or promise to you that if you passed the hand-held breath test, that he/she would let you go home?


41. Did the officer ever advise you that the hand-held test is *100% voluntary, and that you had a right to refuse to take that hand-held test without any penalty or loss of license befalling you*?


42. Did the officer ever indicate (in any manner or fashion) that by not blowing into the hand-held alcohol tester that you would either lose your license or be subject to immediate arrest?


43. Was there any physical or vocal resistance by you or interference with the officer's arrest procedures by others while you were being detained or when you were arrested?


44. Did you ever advise any of the officers that you came in contact with, at the arrest scene, at the testing site *or at jail*, that you wanted an independent test of your blood or breath?

10. ARREST

1. Were you ever told you were "under arrest" or similar wording to indicate that you were going to jail? If so, please indicate when and by whom.


2. Were you told exactly what you were being *arrested for*?


3. If the officer told you one offense (e.g., "OUI"), did he/she also advise you about being charged with the other traffic offenses for which you were ticketed?


4. What was the last thing you said (or did) before the officer told you that you were under arrest?


5. What was the officer's exact wording to you about your being placed under arrest?

11. CONVERSATION AFTER ARREST

1. What did the officer say or ask first *after* you were arrested?


2. Precisely what was said or asked next and by whom?


3. Were you struck, pushed, injured, verbally abused or "roughed up" by the officer(s) when you were arrested? If so, describe:

12. OTHER PEOPLE PRESENT

1. Were other people present during the arrest process or during the time the field sobriety tests were being given to you? If so, who?


2. If names are not known, describe each of them to the best of your ability and where and when you encountered this person:

13. VEHICLE TOWING OR REMOVAL FROM SCENE [Complete Applicable Parts of This Section]

1. Make, Year and Model of vehicle:


2. What happened to your car?


3. If it was towed, what towing service did so?


4. Were you present when it was taken (towed) from scene?


5. What were you doing (or where were you) when the tow truck arrived?


6. Did the tow truck operator observe any of your "sobriety" testing?


7. Did you speak to the tow operator?


8. Did you get a copy of the tow operator's report?


9. Did you have to sign a permission form?


10. Did you ever hear or notice the officer requesting a "transport" or "tow" vehicle on his/her two-way radio?


11. If "Yes", when did you hear this?


12. Did the arresting officer stay at the scene until the vehicle was towed away?


13. If you had a car phone available, did the officer ever offer to let you call someone to come get your car, or offer an alternate tow company?


14. If "Yes", how long after you were "arrested" did the tow truck arrive?

14. SEARCH OF VEHICLE

1. Was your car searched?


2. Were you present?


3. Was anything removed (missing) from your car or was it "ransacked"?


4. If "Yes", describe in detail:

15. AT STATION/JAIL/TESTING FACILITY

1. If you saw a clock when you arrived, please indicate what time it was:


2. How many officers were there?


3. With whom did have conversations with, if anyone?


4. Were you asked any health or environmental contamination questions, such as "are you taking medication", "do you have false teeth or a bridge", "have you been around any paint vapors or other chemicals today", etc., before you took the State's test? If so, what were you asked, and what was your response to these questions?


5. Were you searched?


6. Were you fingerprinted?


7. Were you videotaped?


8. If you signed any papers, what were they?


9. Did the arresting or testing officer make any statements about you or about the circumstances of your arrest, or about your alcohol "reading", or anything else of significance to other officers?


10. Did the arresting officer (or any officer) ask you about prior OUI offenses or comment to you that your computer record showed prior OUI(s)?


11. Without being asked about this, did you say anything to the officer about prior OUI's that you had? If "yes", give details:


12. Was the arresting officer physically present in the room where you were given the test, and did he/she keep you in view the entire time that you were at the testing facility? Please explain:


13. Did he/she or any other officer(s) in the testing room have their walkie-talkie or portable radios on their belt or shoulder when they were in the testing room?


14. While in the room where the testing was being conducted, did you ever hear or observe an officer (any officer) use radio equipment in communicating with the dispatcher or with other officers? If yes, please give details:


15. Was anyone smoking in the testing room prior to or during the time you were being tested?


16. Did any other officers make comments to the arresting officer or testing officer or to YOU?


17. What did they say?


18. Were you permitted to go to the restroom? If so, when?


19. Were you permitted to make a telephone call? If "Yes" when was this permitted, and who did you call?


20. Were you allowed to smoke, drink water or put *anything* into your mouth within 15 minutes before the test was administered? If so, give details:

16. BREATH TESTS
[The next two sections should be completed by you ONLY if you were administered a breath test at a police precinct/jail or a mobile testing van by the police after your arrest. If you were not taken to a breath machine and asked to blow into the collection tube, skip these sections.]

1. Testing officer's/operator's name:


2. Officer's/Operator's police agency:


3. Officer/Operator present when you arrived?


4. Did officer/operator arrive afterwards? When?


5. Did the operator turn on the breath machine and wait over 20 minutes before asking you to "blow"?


6. Did you ever hear the breath machine give any computer-generated "beeps" or "chirps" before or during your testing? If "Yes, what do you recall hearing, and when did you hear it?


7. When did the testing officer/operator begin "observing" you prior to the testing?


8. Was this observation continuous and uninterrupted?


9. Where was the arresting officer during this time?


10. Please give the times and results of your first, second, and third (if given) breath tests:


11. Was there a witness to your breath test? Who was it?


12. Approximate room temperature and lighting conditions:


13. Did anyone ask to look inside your mouth before you were tested?


14. At the breath testing location, did anyone ask you if you had been around paint vapors, volatile chemicals or solvents during the day prior to when you were stopped?


15. Did anyone ask you about false teeth, "bridge" work or dental plates?


16. Details:


17. Did you have a "fever" or elevated body temperature when tested? If so, was the elevated body temperature from: Dancing? Exercising? Sunbathing? Something else? Indicate other cause:


18. Are you a smoker?


19. Did you smoke while being transported to the breath testing location, or upon arrival there?


20. Did you have any difficulty performing the breath test? If so, give details.


21. If a repeat "blow" was required on the official chemical sobriety test (*not* the hand-held test), was the mouthpiece changed each time?


22. In the 12 hours immediately prior to being tested on a breath machine, were you exposed to (i.e., breath or work with) solvents, cleaning solutions, paints, active, mineral spirits or any similar caustic or aromatic products? If so, please describe:


23. Did you ingest or smoke anything containing menthol on the day in question? If so, describe:

17. CONVERSATION WITH BREATH TESTING OPERATOR

1. Did the breath-testing operator ask you any questions? If so, what did s/he ask?


2. Did the breath test operator give you any instructions or explain how the machine worked or how you were to "blow" into the machine? If so, what were the instructions?


3. Was the arresting officer present and observing all procedures at all times during the testing procedures?


4. When you gave the breath sample, was your body in an upright position (perpendicular to the floor), or were you leaning forward to reach the mouthpiece from a sitting or standing position? Describe in detail:


5. Did you get to see the numerical reading shown on the front of the machine? Explain:

18. BLOOD TESTS
[THIS SECTION SHOULD ONLY BE COMPLETED IF YOU WERE GIVEN A BLOOD TEST BY THE POLICE.]

1. Where were you taken to obtain the blood test?


2. Who took you for a blood test?


3. When did this occur, in relation to your time of arrest?


4. Had you already given a breath sample before being taken for a blood test?


5. Did you consent to having this blood sample taken from you?


6. What were you told or asked by the police in order to obtain your consent for this sample to be taken from you?


7. Who drew (took) your blood sample?


8. Were you required to sign any forms before the nurse/doctor/technician would take your blood? If so, what did you sign?


9. Did the person who took your blood sample use any type of cloth or swab to cleanse the surface of your skin before taking the sample? If so, please describe what was done to prepare the skin:


10. As the needle was removed from your arm, did the person who took the sample hold a swab or cloth over the puncture site?


11. What happened to the blood sample after it was collected from you? (Be as specific as possible)


12. Were you told (or were you under the impression) that if the police took a blood test that you could not request your own independent test of your blood or breath, by a different medical or laboratory provider?

19. RIGHT TO COUNSEL

1. Were you ever advised by anyone that you had the right to consult with an attorney? If "Yes", by whom and when?


2. Did you ever ask to call an attorney? Did you know a number?


3. Did you have the opportunity to make the phone call? If so, when?


4. If you were denied the right to call an attorney before deciding whether to take the State's test, did the officer (or anyone at the station) explain why you were being denied access to legal counsel? If so, what was the reason?


5. Were you given a phone book?


6. Did you ask for a phone book?


7. Were you physically able to read that night (i.e., coherent and not impeded or restrained)?


8. Who told you that you could call an attorney? When?


9. When were you told you could make a phone call to anyone else, if you desired?


10. Did the police cooperate with you in providing phone access?


11. If not, or if you were delayed in being provided phone access, or if the police limited your calls, give details:


12. Could you talk privately?


13. Were the police listening in on your conversation?

20. FORMS SIGNED

14. Did you ever sign your name?


15. What documents did you sign and why?


16. Did you ever *refuse* to sign your name on any document(s)? If so, why and what document(s)?

21. VIDEO OR AUDIO TAPING

17. Do you know if a video or audiotape was made at the arrest scene or at the station?


18. Any clue(s) (i.e., officer mentioned it) that a tape may have been being made? Explain:


19. Did you know that a tape was being made when it was being made?

22. RELEASE FROM JAIL

1. What was the date and time of your release?


2. Were you released to someone? If so, please include their name, address, and phone number.


3. How did that person know to come to assist you?


4. Any conversation with him/her? What did you talk about?


5. Was there any discussion about getting an independent test? If so, give details:

22. ACCIDENT
[*This section is to be completed ONLY IF an accident of some type has occurred in connection with your DUI arrest.*]

1. Were you involved in an accident?


2. One car or more than one car involved?


3. Describe accident:


4. Were you inside your vehicle when the officer first arrived on the scene?


5. If "no," give details of where you were in relationship to the vehicles:


6. Were other persons from your vehicle there, too?


7. After the accident, did you ever leave the immediate area (for any purposes, such as to call a tow truck, call police, etc.)? If so, give details of how long you were gone, where you went, why you left, etc.:


8. Were there any injuries to any other person(s)? If so, give full details:


9. Did an airbag deploy inside your vehicle? If so, give details of how it affected you:


10. Did the arresting officer make it clear to you at what point of the investigation that he/she was terminating the *ACCIDENT* investigation and BEGINNING the *CRIMINAL* investigation for suspected drunk driving against you?


11. Give details about what questions the police asked, by whom, and at what location they asked the questions:


12. Did the officer ever ask you about what you had had to drink and when it had been consumed?


13. Were you given any Miranda advisements before the officer(s) began to question you?


14. Prior to this case, had you EVER been the driver of a vehicle in which another person [passenger, person(s) in other car, pedestrian(s)] were injured or killed? If so, give details:

23. DRIVING AND CRIMINAL RECORD
[*NOTE: The prosecutor will have this information, and I must know the entire history to be able to properly analyze your chances at trial.*]

1. Have you ever been arrested anywhere for anything?

If so, where, what were the charges and how was the case disposed of?


2. Have you had a prior DUI in your LIFETIME ANYWHERE?


3. If so, give details below. Include as much of the following as you can: the city and state, case or citation number, the court the case was handled in, the attorney the case was handled by, whether it was a plea or went to trial, and the result.


4. List *any other* DUI convictions (including nolo contendere pleas) during your lifetime anywhere. Include all of the information for each case you included in question 266. Be as specific as possible.


5. Have you ever been declared a "habitual traffic offender" (HTO) for your prior driving offenses? When?


6. Are you on probation for any other offense(s)? If so, give details:


7. Was your license under suspension in any jurisdiction when arrested in this case? Give details:


8. Were you driving on a "hardship license" or other restricted license when this incident occurred?


9. Prior Driving Suspension (whether in effect now or not)? Give details:


10. Prior SERIOUS Traffic Violations (racing, attempting to elude an officer, hit and run, leaving the scene of an accident, etc.) [List offense(s) below and approximate date(s) of occurrence]


11. Prior Minor Traffic Violations [List offense(s) and approximate date(s) of occurrence]


12. Prior criminal record of any type (not already mentioned), especially alcohol-related or drug-related charges, such as "underage possession of alcohol", "open container violation", possession of marijuana, public intoxication:

24. REFUSAL OF THE STATE'S BREATH or BLOOD TESTS
[*Complete this section ONLY IF you REFUSED (or allegedly refused) to submit to the State's breath, or blood tests as requested by the arresting officer.*]

1. What actions were taken or statements were made by the police officer to you just prior to your alleged refusal to take the state's test(s)?


2. Why did you refuse (or why did the officer claim that you refused) the State's test(s):


3. In what way (or with what words or conduct) did you (allegedly) refuse the State's test?


4. Were you aware that your license (or privilege to drive on Massachusetts highways) would be suspended for refusing to submit to the State's test(s)?


AUTOBIOGRAPHY
I want to get to know my clients as People and not just as defendants. Please write as long or short an autobiography as you'd like.

ALL ABOVE INFORMATION IS PROTECTED BY THE ATTORNEY CLIENT PRIVILEGE

Joseph Waldbaum, Esq. 978 921 4100 Fax 978 349 6800

24 / 7 Cell phone: 978 921 4100 Fax: 978 349 6800 joseph@waldbaumlaw.com

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