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
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
Name of Court (on
Court Date (on
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
Results shown on printout: Reported value %
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
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
Have you received blood test results? YES NO NOT
Did you refuse to
take a test? YES NO NOT
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
Have you ever been convicted of DWI or DUI? YES NO NOT