22 CRR-NY D VI Form 5aNY-CRR
22 CRR-NY D VI Form 5a
22 CRR-NY D VI Form 5a
5a Nav. L. chemical tests—order
Sec. 49 Nav. L.
Form 5A
(Nav. L. Chemical
Tests – Order)
9/89
__ Court of __ County of __
___________ x
In the Matter of the Application of
_______
,
Indictment/Docket
[name of applicant]
No.
__
for an order to compel
ORDER COMPELLING
SUBMISSION TO A
_______
to
CHEMICAL TEST [name of arrestee] submit to a chemical test, pursuant to Nav. L. § 491 ___________ x
Upon the application [affidavit] of
sworn to [dated] __, 19 ,
[name of applicant]
for an order pursuant to section 49 of the Navigation Law to require
to submit
[name of arrestee]
to a chemical test, and sufficient reason appearing therefor, it is
ORDERED that the arrestee submit to a chemical test of the alcoholic or drug content of his/her blood, and it is further
ORDERED that a person authorized pursuant to section 49(4)(e)(1) of the Navigation Law, em-
ployed at
withdraw a proper amount of blood from the arrestee, for the purpose of
[name of facility] conducting such chemical test.
E N T E R
, New York
[location]
Date:
, 19
Time:
[a.m.] [p.m.]
Judge [Justice]
Applicant (if order issued orally)
Footnotes
1
Strike all items not applicable
22 CRR-NY D VI Form 5a
Current through May 31, 2021
End of Document |