Form DI-27 "Intoxicant Level Law Enforcement Officer's Report to the Secretary of State" - Maine

What Is Form DI-27?

This is a legal form that was released by the Maine Department of the Secretary of State - a government authority operating within Maine. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2013;
  • The latest edition provided by the Maine Department of the Secretary of State;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DI-27 by clicking the link below or browse more documents and templates provided by the Maine Department of the Secretary of State.

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Download Form DI-27 "Intoxicant Level Law Enforcement Officer's Report to the Secretary of State" - Maine

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Department of the Secretary of State
Bureau of Motor Vehicles
INTOXICANT LEVEL
LAW ENFORCEMENT OFFICER’S REPORT TO THE SECRETARY OF STATE
NAME: ___________________________________________________
DATE OF BIRTH: ________________________________
STREET ADDRESS: ________________________________________
TIME OF OFFENSE: _____________________________
CITY: ____________________________________________________
DATE OF OFFENSE:______________________________
STATE/ZIP CODE: __________________________________________
PLACE OF OFFENSE: ____________________________
THE ABOVE-NAMED PERSON OPERATED OR ATTEMPTED TO OPERATE (check all boxes that apply):
ALC LEVEL
a motor vehicle while having an alcohol level of 0.08 grams or more of alcohol per 100 milliliters of blood or
0.08 grams
210 liters of breath
ANY ALC
a motor vehicle license while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or
COND
210 liters of breath with a conditional license
PASS<
a motor vehicle with a passenger under 21 years of age
21 YRS
DRUGS
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ALC LEVEL
a commercial motor vehicle while having an alcohol level of 0.04 grams or more of alcohol per 100 milliliters of
0.04 grams-
blood or 210 liters of breath
CMV
ALC LEVEL
a commercial motor vehicle containing hazardous materials while having an alcohol level of 0.04 grams or more
0.04 grams-
of alcohol per 100 milliliters of blood or 210 liters of breath
HAZMAT
ANY ALC
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or 210 liters of
MINOR
breath while under 21 years of age
FATAL
a motor vehicle involved in an accident where a death has or will occur
OFFICER’S STATEMENT OF PROBABLE CAUSE: _____________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
(Continue statement on reverse)
Sworn before me under oath:
_________________________________________
________________________________________________
(Notary Public)
(Signature of Officer)
Dated: ___________________________________
________________________________________________
(Officer’s Name Printed or Typed)
End Commission Date: ______________________
________________________________________________
(Department of Officer)
THIS FORM MUST BE RETURNED TO THE SECRETARY OF STATE IMMEDIATELY
Bureau of Motor Vehicles, 29 State House Station, Augusta, Maine, 04333-0029
Telephone: 207-624-9000 Extension: 52106
DI-27 Rev. 01/2013
Web: www.maine.gov/sos/bmv
Department of the Secretary of State
Bureau of Motor Vehicles
INTOXICANT LEVEL
LAW ENFORCEMENT OFFICER’S REPORT TO THE SECRETARY OF STATE
NAME: ___________________________________________________
DATE OF BIRTH: ________________________________
STREET ADDRESS: ________________________________________
TIME OF OFFENSE: _____________________________
CITY: ____________________________________________________
DATE OF OFFENSE:______________________________
STATE/ZIP CODE: __________________________________________
PLACE OF OFFENSE: ____________________________
THE ABOVE-NAMED PERSON OPERATED OR ATTEMPTED TO OPERATE (check all boxes that apply):
ALC LEVEL
a motor vehicle while having an alcohol level of 0.08 grams or more of alcohol per 100 milliliters of blood or
0.08 grams
210 liters of breath
ANY ALC
a motor vehicle license while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or
COND
210 liters of breath with a conditional license
PASS<
a motor vehicle with a passenger under 21 years of age
21 YRS
DRUGS
a
m
o
t
o
r
v
e
h
i
c
l
e
w
h
i
l
e
h
a
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ALC LEVEL
a commercial motor vehicle while having an alcohol level of 0.04 grams or more of alcohol per 100 milliliters of
0.04 grams-
blood or 210 liters of breath
CMV
ALC LEVEL
a commercial motor vehicle containing hazardous materials while having an alcohol level of 0.04 grams or more
0.04 grams-
of alcohol per 100 milliliters of blood or 210 liters of breath
HAZMAT
ANY ALC
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or 210 liters of
MINOR
breath while under 21 years of age
FATAL
a motor vehicle involved in an accident where a death has or will occur
OFFICER’S STATEMENT OF PROBABLE CAUSE: _____________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
_____________________________________________________________________________________________________________
(Continue statement on reverse)
Sworn before me under oath:
_________________________________________
________________________________________________
(Notary Public)
(Signature of Officer)
Dated: ___________________________________
________________________________________________
(Officer’s Name Printed or Typed)
End Commission Date: ______________________
________________________________________________
(Department of Officer)
THIS FORM MUST BE RETURNED TO THE SECRETARY OF STATE IMMEDIATELY
Bureau of Motor Vehicles, 29 State House Station, Augusta, Maine, 04333-0029
Telephone: 207-624-9000 Extension: 52106
DI-27 Rev. 01/2013
Web: www.maine.gov/sos/bmv