Form DI-140 "Law Enforcement Officer's Report Relating Toimplied Consent" - Maine

What Is Form DI-140?

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-140 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-140 "Law Enforcement Officer's Report Relating Toimplied Consent" - Maine

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Department of the Secretary of State
Bureau of Motor Vehicles
REFUSAL
LAW ENFORCEMENT OFFICER’S REPORT RELATING TO IMPLIED CONSENT
NAME: ___________________________________________________
DATE OF BIRTH: ________________________________
STREET ADDRESS: ________________________________________
DATE OF OFFENSE: ______________________________
CITY: _____________________________________________________
TIME OF OFFENSE:_______________________________
STATE/ZIP CODE:___________________________________________
PLACE OF OFFENSE:_____________________________
1.
By operating or attempting to operate a motor vehicle in this State you have a duty to submit to and complete chemical tests to
determine your alcohol level and drug concentration.
2.
I will give you a breath test unless I decide it is unreasonable, in which case another chemical test will be given. If you are requested to
take a blood test you may ask that a physician perform the test if a physician is reasonably available.
3.
If you fail to comply with your duty to submit to and complete chemical tests, your driver’s license or permit or right to apply for or
obtain a license, will be suspended for a period up to 6 years. Your failure to submit to a chemical test is admissible against you at any
trial for operating while under the influence of intoxicating liquor or drugs. If you are convicted of operating while under the influence
of intoxicating liquor or drugs, your failure to submit to a chemical test will be considered an aggravating factor at sentencing which in
addition to other penalties, will subject you to a mandatory minimum period of incarceration.
4.
If you are 21 years of age or older, an additional 275 days of suspension will be imposed if you had a passenger under 21 with you in the
vehicle at the time of the offense. If you are less than 21 years old, an additional 180 days of suspension will be imposed if you had a
passenger under 21 with you at the time of the offense.
I have been advised of the consequences listed in paragraphs 3 and 4 above of failure to comply with the duty to submit to and complete a chemical
test at the request of an officer and DO NOT WISH TO SUBMIT TO A TEST.
__________________________________________________________
(Signature of Person Refusing Test)
TO THE SECRETARY OF STATE:
This officer had probable cause to believe that the above-named person was operating or attempting to operate (check all boxes that apply):
OUI -ALC
a motor vehicle while under the influence of intoxicants
ANY ALC
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of
COND
blood or 210 liters of breath with a conditional license
DRUGS
a motor vehicle while under the influence of drugs
ALC LEVEL
.04/CMV
a commercial motor vehicle while having an alcohol level of 0.04 grams per 100 milliliters of blood or
210 liters of breath, or
HAZ MAT
containing hazardous materials while having an alcohol level of 0.04 grams per 100 milliliters of
blood or 210 liters of breath
ANY ALC/MINOR
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or
210 liters of breath while under 21 years of age
PASS<21 YRS
a motor vehicle with a passenger under 21 years of age
FATAL
a motor vehicle involved in an accident where a death has or will occur
A law enforcement officer informed the above-named person of the duty to submit and complete a chemical test and of the consequences of the
failure to comply with that duty. The above-named person, after being informed, failed to submit to and complete a chemical test.
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-140 Rev. 01/2013
Web: www.maine.gov/sos/bmv
Department of the Secretary of State
Bureau of Motor Vehicles
REFUSAL
LAW ENFORCEMENT OFFICER’S REPORT RELATING TO IMPLIED CONSENT
NAME: ___________________________________________________
DATE OF BIRTH: ________________________________
STREET ADDRESS: ________________________________________
DATE OF OFFENSE: ______________________________
CITY: _____________________________________________________
TIME OF OFFENSE:_______________________________
STATE/ZIP CODE:___________________________________________
PLACE OF OFFENSE:_____________________________
1.
By operating or attempting to operate a motor vehicle in this State you have a duty to submit to and complete chemical tests to
determine your alcohol level and drug concentration.
2.
I will give you a breath test unless I decide it is unreasonable, in which case another chemical test will be given. If you are requested to
take a blood test you may ask that a physician perform the test if a physician is reasonably available.
3.
If you fail to comply with your duty to submit to and complete chemical tests, your driver’s license or permit or right to apply for or
obtain a license, will be suspended for a period up to 6 years. Your failure to submit to a chemical test is admissible against you at any
trial for operating while under the influence of intoxicating liquor or drugs. If you are convicted of operating while under the influence
of intoxicating liquor or drugs, your failure to submit to a chemical test will be considered an aggravating factor at sentencing which in
addition to other penalties, will subject you to a mandatory minimum period of incarceration.
4.
If you are 21 years of age or older, an additional 275 days of suspension will be imposed if you had a passenger under 21 with you in the
vehicle at the time of the offense. If you are less than 21 years old, an additional 180 days of suspension will be imposed if you had a
passenger under 21 with you at the time of the offense.
I have been advised of the consequences listed in paragraphs 3 and 4 above of failure to comply with the duty to submit to and complete a chemical
test at the request of an officer and DO NOT WISH TO SUBMIT TO A TEST.
__________________________________________________________
(Signature of Person Refusing Test)
TO THE SECRETARY OF STATE:
This officer had probable cause to believe that the above-named person was operating or attempting to operate (check all boxes that apply):
OUI -ALC
a motor vehicle while under the influence of intoxicants
ANY ALC
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of
COND
blood or 210 liters of breath with a conditional license
DRUGS
a motor vehicle while under the influence of drugs
ALC LEVEL
.04/CMV
a commercial motor vehicle while having an alcohol level of 0.04 grams per 100 milliliters of blood or
210 liters of breath, or
HAZ MAT
containing hazardous materials while having an alcohol level of 0.04 grams per 100 milliliters of
blood or 210 liters of breath
ANY ALC/MINOR
a motor vehicle while having an alcohol level of more than 0.00 grams per 100 milliliters of blood or
210 liters of breath while under 21 years of age
PASS<21 YRS
a motor vehicle with a passenger under 21 years of age
FATAL
a motor vehicle involved in an accident where a death has or will occur
A law enforcement officer informed the above-named person of the duty to submit and complete a chemical test and of the consequences of the
failure to comply with that duty. The above-named person, after being informed, failed to submit to and complete a chemical test.
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-140 Rev. 01/2013
Web: www.maine.gov/sos/bmv