State of Wisconsin Criminal Division Milwaukee County

CIRCUIT COURT STATE OF WISCONSIN CRIMINAL DIVISION MILWAUKEE COUNTY

STATE OF WISCONSIN, Plaintiff CRIMINAL COMPLAINT

VS. Operating a Motor Vehicle While Under the Influence of an Intoxicant (4th) within 5 Years of a Prior Offense Operating a Motor Vehicle With a Prohibited Alcohol Concentration (4th) within 5 Years of a Prior Offense Def Name Def Address CASE NUMBER Def City State Zip Def DOB, (DOB) Defendant. COMPLAINING WITNESS: Complaining Witness

The above-named complainant, being first duly sworn, states that the above-named defendant, in Milwaukee County, Wisconsin,

OPERATING A MOTOR VEHICLE WHILE UNDER THE INFLUENCE OF AN INTOXICANT - PRIOR WITHIN 5 YEARS on Date, at Location, City, within 5 years of a prior offense which is counted under §343.307(1), did unlawfully operate a motor vehicle while under the influence of an intoxicant, contrary to Wisconsin Statute sections 346.63(1) (a) and 346.65(2)(am)4m.

OPERATING A MOTOR VEHICLE WITH A PROHIBITED ALCOHOL CONCENTRATION OF MORE THAN 0.02%. – PRIOR WITHIN 5 YEARS on Date, at Location, City, within 5 years of a prior offense which is counted under §343.307(1), did unlawfully operate a motor vehicle while under the influence of an intoxicant, contrary to Wisconsin Statute sections 346.63(1) (b), 340.01(46m)(c), and 346.65(2)(am)4m.

PENALTIES Upon conviction of this offense, a Class H felony, the defendant shall be fined not less than $600 nor more than $10,000 and shall be imprisoned for not less than 6 months nor more than 6 years.

PENALTY ENHANCER If the defendant had an alcohol concentration of 0.17 to 0.199, the applicable minimum and maximum fines are doubled. If the defendant had an alcohol concentration of 0.20 to 0.249, the applicable minimum and maximum fines are tripled. If the defendant had an alcohol concentration of 0.25 or above, the applicable minimum and maximum fines are quadrupled.

IGNITION INTERLOCK ORDER Pursuant to Wisconsin Statute sections 343.301(1g) and (1m), upon conviction of this offense, the court shall order that the defendant’s operating privileges for Class D vehicles be restricted to operating vehicles equipped with an ignition interlock device (IID) and shall order that each motor vehicle for which the defendant’s name appears on the certificate of title or registration be equipped with an IID, unless the court finds that equipping each motor vehicle with an IID would cause an undue financial hardship.

PROBABLE CAUSE Complainant is a law enforcement officer employed by the Jurisdiction, and bases this complaint on official reports prepared by Officer Name, which are of the kind that complainant has used in the past and found to be accurate and reliable, and which complainant knows are prepared in the regular course of that department’s business.

Those reports reveal that on the above-stated date and at the above stated location, Officer Name observed Facts Information. Based upon these observations, Officer Name believed the defendant to be intoxicated.

As to defendant’s operation of a motor vehicle: A. The defendant told Officer Name that he was operating a Type of Motor Vehicle on Date, at Location, City.

B. Officer Name took a statement from Name, an adult citizen, who stated that he personally observed the defendant operating a Type of Motor Vehicle on Date, at Location, City.

C. Officer Name observed the defendant operating a Type of Motor Vehicle on Date, at Location, City.

As to the chemical test: A. The defendant submitted to an Intoximeter breath test, which was conducted according to procedure by Name, a certified Intoximeter operator, within three hours of defendant’s operation of the motor vehicle. The result showed that the defendant’s breath contained Number grams of alcohol in 210 liters of breath. Certifications concerning the instrument pursuant to section 343.305(6)(b)3 will be available by calling (414) 278-4374.

B. The defendant was conveyed to Hospital where, within three hours of defendant’s operation of the motor vehicle, Name drew a sample of the defendant’s blood for chemical analysis. An analysis conducted by Chemist shows that the defendant’s blood contained Percentage% weight of alcohol.

This complaint is further based upon the records of the Wisconsin Department of Transportation, Division of Motor Vehicles, which the complainant has used in the past and found to be accurate and reliable. Those records indicate that the defendant has been convicted of or revoked for an OWI related offense, as counted under §343.307(1), on three prior occasions, and that at least one of those offense occurred within the 5 years preceding this offense:

Arrest Date Conviction Date County / State of Offense Offense Offense date Conviction date County / State Offense Offense date Conviction date County / State Offense Offense date Conviction date County / State Offense

Further, complainant states that Location, City, is in Milwaukee County, Wisconsin.

END OF COMPLAINT

Subscribed and sworn to before me and approved for filing this _____ day of ______, 20 .

______ASSISTANT/DEPUTY DISTRICT ATTORNEY COMPLAINING WITNESS Name Printed: ______State Bar Number: ______07.01-OWI4&PAC4–WI5 CIRCUIT COURT STATE OF WISCONSIN CRIMINAL DIVISION MILWAUKEE COUNTY

STATE OF WISCONSIN, Plaintiff INFORMATION

VS. Operating a Motor Vehicle While Under the Influence of an Intoxicant (4th) within 5 Years of a Prior OWI Offense DEF NAME Operating a Motor Vehicle With a Prohibited Alcohol DEF ADDRESS Concentration (4th) within 5 Years of a Prior OWI Def City State Zip Offense Error: Reference source not found, (DOB) Defendant. CASE NUMBER

COMPLAINING WITNESS: Complaining Witness

I, JOHN T. CHISHOLM, DISTRICT ATTORNEY FOR MILWAUKEE COUNTY, WISCONSIN, HEREBY INFORM THE COURT THAT THE ABOVE-NAMED DEFENDANT, IN THE COUNTY OF MILWAUKEE, STATE OF WISCONSIN,

OPERATING A MOTOR VEHICLE WHILE UNDER THE INFLUENCE OF AN INTOXICANT– PRIOR WITHIN 5 YEARS on Date, at Location, City, within 5 years of a prior offense which is counted under §343.307(1), did unlawfully operate a motor vehicle while under the influence of an intoxicant, contrary to Wisconsin Statute sections 346.63(1)(a) and 346.65(2)(am)4m.

OPERATING A MOTOR VEHICLE WITH A PROHIBITED ALCOHOL CONCENTRATION OF MORE THAN 0.02%. – PRIOR WITHIN 5 YEARS on Date, at Location, City, within 5 years of a prior offense which is counted under §343.307(1), did unlawfully operate a motor vehicle while having a prohibited alcohol concentration of more than 0.02%, contrary to Wisconsin Statute sections contrary to Wisconsin Statute sections 346.63(1)(b), 340.01(46m)(c), and 346.65(2) (am)4m.

JOHN T. CHISHOLM DISTRICT ATTORNEY

______DATED DEPUTY/ASSISTANT DISTRICT ATTORNEY Name Printed: ______State Bar Number: ______