1. The date and time of your arrest.

2. The city and county of your arrest.

3. The police department of the officer who arrested you.

4. Why the police say they stopped you.

5. The type of tests, if any, you were subjected on the roadside (eye test, walking test, standing on one leg test, portable breath test, etc.).

6. Whether you refused any roadside tests.

7. Whether you took a blood or breath test and the results.

8. Whether you refused to take any blood or breath tests.

9. Whether you asked for any type of independent test.

10. Whether you have ever been charged with or convicted of DUI.

11. Whether the police took your drivers license.

12. The impact a DUI conviction would have on your job, school, or family.