? TED LOTHSTEIN AND GENE STRUCKHOFF - AN EXPERIENCED NEW HAMPSHIRE DUI/DWI DEFENSE TEAM

LOTHSTEIN GUERRIERO, PLLC

TED LOTHSTEIN AND GENE STRUCKHOFF - AN EXPERIENCED NEW HAMPSHIRE DUI/DWI DEFENSE TEAM

QUESTIONNAIRE

Please fill out this online-form. When you are finished, click on the "SUBMIT" - Button at the end.

INFORMATION SUBMITTED TO THIS OFFICE IS PROTECTED BY THE ATTORNEY-CLIENT PRIVILEGE AND WILL NOT BE SHARED
WITH ANYONE OUTSIDE OF LOTHSTEIN GUERRIERO, LLC, WITHOUT YOUR PRIOR PERMISSION.

First Name   M.I.   Last Name
Address 1

Address 2

City
  State    ZIP Code

Preferred phone # for call about initial consultation

Best time to reach you at this #


E-Mail address
   May we e-mail you at this address? Yes    No


Date of Birth           State in which you hold driver’s license    CDL   Yes    No


Name of Court (on summons, complaint, or bail receipt.)


Court Date (on summons, complaint, or bail receipt.)


Date of Alleged DWI Offense     Time of Alleged DWI Offense


Location of Alleged DWI/DUI offense (City or Town)


Why were you stopped, according to Officer?


Did you take a breath test? YES    NO    NOT SURE     Results shown on printout: Reported value   %


WARNING If you either refused a test or submitted to a test showing at or above the legal limit of .08% (.02%, if you are under 21, and .04%, if you were driving a commercial vehicle), you face an automatic suspension of your license or right to operate in New Hampshire for at least 180 days and for up to two years. Although you have a right to a hearing, a proper written request for such a hearing must be filed with the department of safety within 30 days. The rules for such filings are technical. Please call right away in order to preserve your right to such a hearing or if you have any questions about your rights or the legal limit that applies to you.

Did you take a blood test? YES    NO    NOT SURE


Have you received blood test results? YES    NO    NOT SURE    Result %


Did you refuse to take a test? YES    NO    NOT SURE


WARNING If you have been previously convicted of dwi/dui within the last seven years in any state, you face a mandatory jail sentence in New Hampshire if convicted.

 

Is this your first DWI/DUI arrest? YES    NO    NOT SURE


Have you ever been convicted of DWI or DUI? YES    NO    NOT SURE