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

This "Form Di-27 "intoxicant Level Law Enforcement Officer'S Report to the Secretary of State" - Maine" is a part of the paperwork released by the Maine Department of the Secretary of State specifically for Maine residents.

The latest fillable version of the document was released on January 1, 2013 and can be downloaded through the link below or found through the department's forms library.

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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
v
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a
p
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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
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