IN THE JUSTICE COURT OF COUNTY, STATE OF MONTANA

BEFORE , JUSTICE OF THE PEACE

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STATE OF MONTANA, * CAUSE NO.

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Plaintiff, * COMPLAINT

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vs. * (DUI & DUI Per Se)

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, *

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Defendant. *

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The undersigned County Attorney of County, Montana, states: before the filing of this Complaint, the above-named Defendant on or about the day of , 19 , committed the offenses of:

COUNT I

Operation of a vehicle by a person with alcohol concentration of 0.10 or more as specified in M.C.A. 61-8-406; and;

COUNT II

Driving or in actual physical control of a vehicle upon the ways of this state open to the public under the influence of alcohol as specified in M.C.A. 61-8-401.

THE FACTS CONSTITUTING THE OFFENSES ARE:

was driving and in actual physical control of a vehicle, a Pickup/Car, upon the ways of this state open to the public, while the alcohol concentration in his/her breath and blood was 0.10 or more, by a tested concentration of . , all of which is contrary tothe form, force, and effect of the statute in such case made and provided, force, and effect of the statute in such case made and provided, and against the peace and dignity of the State of Montana.

DATED this day of , 19 .

Name

County Attorney

SUBSCRIBED AND SWORN TO before me this day of

, 19 .

Justice of the Peace