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Exercise of Individual Rights under
the 4th and 5th Amendments



Other than providing my driver's license and proof of insurance, I do not wish to provide any information until I have consulted with my attorney. If my lawyer cannot be reached, I would like a public defender. I would like to talk to my lawyer now.

If you wish to question me, or wish to obtain a waiver, I want my lawyer present. I do not want my person, car or other property to be searched. I do not want to perform any physical acts or tests. I do not want to participate in a line up, nor do I consent to being recorded.

If requested to take a breath test, I want to talk to a lawyer first. If I cannot get legal advice, I will submit to the test only if my driver's license will otherwise be suspended or revoked. If a breath test is given, I also want an independent blood test.

If I am under arrest, I would like to arrange to secure my property. I do not consent to any impound or inventory of my vehicle or other property, but I do waive any claim against you for theft, loss or damage if you allow me to safeguard my own property. If I am not under arrest, I want to leave. Please tell me so I may go on my way. Thank you.