FIREARMS

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					                                             FIREARMS
                                    IMPLIED CONSENT ADVISORY
                                              (Effective May 28, 2003)

_______________________________________________, I believe you have been carrying a pistol on or
              (Person Arrested)
about your person or clothing in a public place in violation of Minnesota’s firearms laws and you have been
placed under arrest for this offense, or you have been involved while carrying a firearm in a firearm related
accident resulting in property damage, personal injury, or death, or you have refused to take a preliminary
screening test or the test was administered and indicated an alcohol concentration of 0.04 or more.

________ 1. Minnesota law requires you to take a test to determine:
(Check when
read)
                 (Check applicable portion when read)

                 ______ a. if you are under the influence of alcohol.

                 ______ b. if you are under the influence of hazardous or controlled substances.


________ 2. Refusal to take a test may result in a civil penalty of $500 and revocation of your permit
(Check when to carry a pistol for a period of one year from the date of refusal.
read)

________ 3. Because I have probable cause to believe you are impaired by a controlled substance that
(Check when is not subject to testing by breath, a blood or urine test is being required of you.
read)
_______       4. (READ ONLY IF PROBABLE CAUSE TO BELIEVE VIOLATION OF
(Check when   CRIMINAL HOMICIDE, ASSAULT LAWS, MINN. STAT. § 609.66, OR OTHER
read)
              CRIME FOR WHICH INVOLUNTARY TESTING BASED UPON PROBABLE
              CAUSE IS PERMITTED.)
              Because I also have probable cause to believe you have violated the criminal homicide or
              injury laws, a test will be taken with or without your consent.

_______       5. Before making your decision about testing, you have the right to consult with an
(Check when   attorney. If you wish to do so, a telephone will be made available to you. If you are unable
read)
              to contact an attorney, you must make the decision on your own. You must make your
              decision within a reasonable period of time.

_______       6. If the test is unreasonably delayed or if you refuse to make a decision, you will be
(Check when   considered to have refused the test.
read)

Do you understand what I have just explained? _____ Do you wish to consult with an attorney? ______

Time telephone made available:        Start: ___________      Stopped: ________________

Will you take the (Breath) (Blood or Urine) test? ______________
(If person refuses:)
What is your reason for refusing? _____________________________________________________________
_________________________________________________________________________________________

Name of Officer:_____________________________Time Completed: ________Date: __________________