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 (DUI Per Se)

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vs. *

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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 , at approximately hours, committed the offense of operation of a vehicle by a person with alcohol concentration of 0.10 or more as specified in M.C.A. 61-8-406.

The facts constituting the offense are:

was driving and in actual physical control of a vehicle, a , upon the ways of this state open to the public, approximately miles of I- on the road, while the alcohol concentration of . , all of which is contrary to the form, 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 this day of , 19 .

Justice of the Peace