DUI Blood, DUI Blood Alcohol Analyses, Florida DUI Blood Alcohol Analyses Affidavit

Florida DUI Blood Alcohol Analyses Affidavit

I, ____________________________________________________________, do hereby swear or affirm that I
                                                                                                            (Printed name of analyst)
hold a valid Florida Department of Law Enforcement Permit to Conduct Blood Alcohol Analyses and that I
analyzed a specimen which the record reflects was obtained from
_______________________________________________________ on _____________ at ____________.
                                                                                                (Subject name)                                                                                                                                                 (Date)                                      (Time)
The analyses performed were conducted in accordance with the provisions of Chapter 11D-8, Florida
Administrative Code.  The results of the analyses were 0.____________ and 0.____________ grams of alcohol
per 100 mL. of blood.  The analytical method used was:
_____ Gas Chromatography       _____ Alcohol Dehydrogenase (Enzymatic)
__________________________________________________________________
(Signature of Analyst)
THIS AFFIDAVIT MUST BE NOTARIZED
STATE OF FLORIDA, COUNTY OF _______________________
Sworn to (or affirmed) and subscribed before me this __________ day of _________________, _______, by
                                                                                                                                                                                                                                                                                                                                                (Month)                                    (Year)
________________________________________________________
(Printed name of analyst making statement)
_______________________________________      _________________________________________________
  (Signature of Notary Public – State of Florida)             (Print, Type or Stamp Commissioned Name of Notary Public)
___ Personally known OR ___ Produced identification Type of identification produced: __________________
NOTE:     Pursuant to Chapter 117.10, Florida Statutes, law enforcement officers, correctional officers, traffic accident investigation officers and traffic infraction enforcement officers               are notaries public when engaged in the performance of official duties.
Use in accordance with Section 316.1934(5), FloridaStatutes..  This form  may also be used in administrative proceedings pursuant to 322.2615, FloridaStatutes.  Forward within 5 days to the local Bureau of Driver Improvement Office, Division of Driver Licenses, Department of Highway Safety and Motor Vehicles.