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Search Warrant For Blood Or Urine DWI Cases CR-155 - North Carolina
| Search Warrant For Blood Or Urine DWI Cases Form. This is a North Carolina form and can be used in Criminal Statewide . |
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File No. STATE OF NORTH CAROLINA In The General Court Of Justice County District Court Division SEARCH WARRANT FOR BLOOD OR URINE IN DWI CASES To any officer with authority and jurisdiction to conduct the search authorized by this Search Warrant: IN THE MATTER OF Name I, the undersigned, find that there is probable cause to believe that the property and person described in the application on the attached sheets and related to the commission of a crime is located as described in the Date Issued Time Issued application. AM PM Name Of Applicant You are commanded to take the person named in the application to a physician, registered nurse or other qualified person to obtain sample(s) of blood and/or urine described in the application from the person named in Name Of Additional Affiant the application. You are to seize the sample(s), have the sample(s) tested for one or more impairing substances and keep the unconsumed sample(s) subject to court order and process the person according to Name Of Additional Affiant law. You are directed to execute this Search Warrant within forty-eight (48) hours from the time indicated on this RETURN OF SERVICE Warrant and make due return to the Clerk of the issuing court. I certify that this Search WARRANT was received and served as follows: Date Received Time Received This Search Warrant is issued upon information furnished under oath by the person or persons shown. AM PM Date Executed Time Executed AM PM I made a search of Date Signature Deputy CSC Assistant CSC CSC Magistrate District Ct. Judge Superior Ct. Judge as commanded. I seized the items listed on the attached inventory. I did not seize any items. This Warrant WAS NOT executed within forty-eight (48) hours of the date and time of issuance and I hereby return it not executed. Signature Of Officer Making Return This Search Warrant was returned to me on the date and time shown below. Department Or Agency Of Officer Date Time AM Signature Deputy CSC Assistant CSC PM Clerk Of Superior Court AOC-CR-155, New 3/02 (Over) 2002 Administrative Office of the Courts <<<<<<<<<********>>>>>>>>>>>>> 2 APPLICATION FOR SEARCH WARRANT FOR BODILY FLUIDS c. The above named individual admitted to me operating the described (Attach additional sheets if necessary.) vehicle at the time and place indicated. Name Of Law Enforcement Officer (Applicant) Rank N.C. Patrol d. On or about the date stated above, at AM PM: Police/Sheriff I detected a strong moderate faint odor of alcohol Name Of Individual To Be Searched Race coming from the breath of the above named person: Male at the scene. Female Location Of Individual To Be Searched Fluid to be seized at the following hospital . other location Blood Urine .Crime(s) Charged I observed the following behaviors of the individual named above, Commercial DWI. G.S. 20-138.2. which evidence impairment of the persons mental and/or physical DWI. G.S. 20-138.1. Felony Death By Vehicle. G.S. 20-141.4. faculties as follows: Habitual DWI. G.S. 20-138.5. Other (specify) I, the law enforcement officer named above, being duly sworn, request that the Court issue a warrant to search the person of the individual named above, who may be found at the location described above, and to seize sample(s) of the above specified bodily fluid(s) of that individual. e. The above named individual stated to me that before or while operating I swear to the following facts to establish probable cause for the issuance of a search the described vehicle he/she: warrant. had consumed alcohol. I am a sworn law enforcement officer of the above named agency. As such I am was consuming alcohol. empowered to search for and seize evidence described in N. C. General Statutes had consumed controlled substance, to wit: .Chapter 14, Criminal Law, Chapter 20, Motor Vehicle Law, and Chapter 90, Controlled had consumed other impairing substance, to wit: Substances. I have received training in the detection and apprehension of impaired . drivers and the investigation of motor vehicle collisions. I have been a sworn law f. The above named individual refused to submit to a chemical analysis. enforcement officer for over years and during that time I have investigated g. I observed the following facts: over incidents of offenses related to impaired driving. 1. I rely on the facts stated in the following report(s), of which a copy or copies is/are attached and incorporated by reference: (Attach a copy of the report(s) checked below if available and if either contains relevant facts.) Affidavit and Revocation Report (AOC-CVR-1/DHHS 3907). h. Other reliable persons stated to me the following facts: (Note: Name officer or Driving While Impaired Report Form/Alcohol Influence Report Form. witness(es) and list facts related to impairment, vehicle operation, etc.) 2. The following facts establish on or about the day of , , at AM PM, the individual named above was operating a ( commercial motor) vehicle to wit: (type, make and year) on a highway/street public vehicular area in County 3. The above named individual has previously been convicted of one or more at or near the city/town of in violation of offenses involving impaired driving. the statute(s) specified above: Check all that apply. Based on all the foregoing, and on my training in detecting impaired driving violations and my experience as a law enforcement officer, I have formed an opinion satisfactory to myself that a. At the time and place stated above: the above named person had consumed a sufficient quantity of some impairing substance(s) I observed the above named individual operating the above-described to appreciably impair that persons physical or mental faculties or both, and that the person vehicle. drove the above described vehicle on the above described highway or public vehicular area I observed the above-described vehicle being operated in the following while under the influence of impairing substance(s). It is my further opinion that evidence of manner: impairing substance(s) is at this time present in the body or bodily fluids of the above named . person, and that unless a warrant is issued and executed without delay, the evidence may b. On or about the date stated above, at AM PM, I dissipate and be lost. responded to a report of a vehicle crash and, after arriving at the scene, I Date Signature of Applicant SWORN AND SUBSCRIBED TO ascertained that the above named individual was operating the described BEFORE ME vehicle at the time and place stated f
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