22 CRR-NY D VI Form 6aNY-CRR
22 CRR-NY D VI Form 6a
22 CRR-NY D VI Form 6a
6a Nav. L. chemical tests—affidavit
Sec. 49 Nav. L.
Form 6-A
(Nav. L. Chemical
Tests-Affidavit)
3/90
__ Court of __ County of __
___________ x
In the Matter of the Application of
Indictment/Docket
_______
,
No.
__
[name of applicant]
AFFIDAVIT for an order to compel _______ [name of arrestee] to submit to a chemical test, pursuant to Nav. L. § 491 ___________ x
STATE OF NEW YORK
)
) ss.:
COUNTY OF
__
)
_________, being duly sworn, deposes and says that: [name of applicant]
1. I am a [police officer employed by the
] [district
[name of police department]
attorney as defined in CPL § 1.20(32)]
[peace officer acting pursuant to his or her special duties]. At [time] [a.m.][p.m.] on, [date] 19, I placed [name of arrestee] under lawful arrest for
violating subdivision(s) __ of section 49 of the Navigation Law. I make this affidavit in support of an application for an order to compel the arrestee to submit to a chemical test, pursuant to section 49 of the Navigation Law.
2. I have reasonable cause to believe the arrestee was the operator of a vessel as defined in section 49(4)(a)(3) of the Navigation Law, because
.
In the course of such operation a person other than the operator [was killed] [suffered serious physical injury or personal injury as defined in section 10.00 of the Penal Law, in that said person (describe nature and extent of injuries)
].
3. A breath test administered by a police officer in accordance with section 49 of the Navigation Law indicates that alcohol has been consumed by the arrestee.
– OR –
Based on the totality of the following circumstances, there is reasonable cause to believe that the arrestee was operating a vessel in violation of subdivision 4 of section 49 of the Navigation Law (describe specific circumstances indicating violation)
.
4. After being placed under lawful arrest, the arrestee refused to submit to a chemical test in accordance with the provisions of section 49 of the Navigation Law, by (describe circumstances of refusal)
.
– OR –
After being placed under lawful arrest, the arrestee is unable to give consent to a chemical test in accordance with section 49 of the Navigation Law, because (describe incapacity)
.
WHEREFORE, it is respectfully requested that the Court issue an order requiring the arrestee to submit to a chemical test to determine the alcoholic or drug content of his/her blood and directing a person authorized by section 49(4)(e)(1) of the Navigation Law to withdraw a blood sample from the arrestee for the purpose of determining the alcoholic or drug content thereof.
Deponent
Sworn to before me this __ day of __, 19.
Notary Public
Footnotes
1
Strike all items not applicable
22 CRR-NY D VI Form 6a
Current through May 31, 2021
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